Provider Demographics
NPI:1942075304
Name:DELTA MEDI TRANS CA LLC
Entity Type:Organization
Organization Name:DELTA MEDI TRANS CA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHD
Authorized Official - Middle Name:SHAHIM H
Authorized Official - Last Name:ALRAWAHNEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-261-3910
Mailing Address - Street 1:23945 SUNNYMEAD BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3025
Mailing Address - Country:US
Mailing Address - Phone:330-261-3910
Mailing Address - Fax:
Practice Address - Street 1:23945 SUNNYMEAD BLVD STE 4
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3025
Practice Address - Country:US
Practice Address - Phone:330-261-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)