Provider Demographics
NPI:1790172997
Name:TIME EXPRESS LLC
Entity Type:Organization
Organization Name:TIME EXPRESS LLC
Other - Org Name:KINGS AND QUEENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKUR
Authorized Official - Middle Name:ESSA
Authorized Official - Last Name:ELMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-610-8229
Mailing Address - Street 1:6035 UNIVERSITY AVE STE 31
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6343
Mailing Address - Country:US
Mailing Address - Phone:858-610-8229
Mailing Address - Fax:
Practice Address - Street 1:6035 UNIVERSITY AVE STE 31
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6343
Practice Address - Country:US
Practice Address - Phone:858-610-8229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No305R00000XManaged Care OrganizationsPreferred Provider Organization