Provider Demographics
NPI:1760779797
Name:1589 WEST SHAW AVE
Entity Type:Organization
Organization Name:1589 WEST SHAW AVE
Other - Org Name:J&J ENTERPRISE MEDICALTRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ESIOHE
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:IDONI
Authorized Official - Suffix:
Authorized Official - Credentials:AS
Authorized Official - Phone:559-222-6300
Mailing Address - Street 1:8936 E HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9088
Mailing Address - Country:US
Mailing Address - Phone:559-222-6300
Mailing Address - Fax:
Practice Address - Street 1:1589 W SHAW AVE
Practice Address - Street 2:SUITE # 7
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3500
Practice Address - Country:US
Practice Address - Phone:559-222-6300
Practice Address - Fax:559-222-6301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J&J ENTERPRISE MEDICAL TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)