Provider Demographics
NPI:1487193140
Name:GOLDEN STATE NEM TRANSPORTATION.LLC
Entity Type:Organization
Organization Name:GOLDEN STATE NEM TRANSPORTATION.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-906-0485
Mailing Address - Street 1:7107 BROADWAY UNIT 158
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:91945
Mailing Address - Country:UM
Mailing Address - Phone:619-906-0485
Mailing Address - Fax:619-741-2766
Practice Address - Street 1:7107 BROADWAY UNIT 158
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:91945
Practice Address - Country:UM
Practice Address - Phone:619-906-0485
Practice Address - Fax:619-741-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201625210290343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)