Provider Demographics
NPI:1861842981
Name:BENICIA TRANSPORTATION INCORPORATED
Entity Type:Organization
Organization Name:BENICIA TRANSPORTATION INCORPORATED
Other - Org Name:BENICIA TRANSPORTATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:K
Authorized Official - Last Name:KONAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-692-1804
Mailing Address - Street 1:1350 HAYES ST STE C4
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2969
Mailing Address - Country:US
Mailing Address - Phone:510-692-1804
Mailing Address - Fax:
Practice Address - Street 1:1350 HAYES ST STE C4
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2969
Practice Address - Country:US
Practice Address - Phone:510-692-1804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35945OtherPUBLIC UTILITIES COMMISSION OF THE STATE OF CALIFORNIA