Provider Demographics
NPI:1447569058
Name:JBL MED TRANSPORT
Entity Type:Organization
Organization Name:JBL MED TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY ANTHONY
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:RICAFORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-296-2685
Mailing Address - Street 1:3625 BETTMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5203
Mailing Address - Country:US
Mailing Address - Phone:650-296-2685
Mailing Address - Fax:650-878-5674
Practice Address - Street 1:480 COLLINS AVE STE C
Practice Address - Street 2:
Practice Address - City:COLMA
Practice Address - State:CA
Practice Address - Zip Code:94014-3208
Practice Address - Country:US
Practice Address - Phone:650-296-2685
Practice Address - Fax:650-878-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA2145112343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)