Provider Demographics
NPI:1518148261
Name:UMEGBOH, ALEXANDER IFENLIOCHUKWU (CEO)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:IFENLIOCHUKWU
Last Name:UMEGBOH
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4173 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1932
Mailing Address - Country:US
Mailing Address - Phone:510-488-1184
Mailing Address - Fax:510-575-6879
Practice Address - Street 1:4173 MACARTHUR BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1932
Practice Address - Country:US
Practice Address - Phone:510-488-1184
Practice Address - Fax:510-575-6879
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28026610343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)