Provider Demographics
NPI:1649674557
Name:SECURE RADIO & TRANSPORTATION LLC
Entity type:Organization
Organization Name:SECURE RADIO & TRANSPORTATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TESSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MBA
Authorized Official - Phone:619-550-1555
Mailing Address - Street 1:4226 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1503
Mailing Address - Country:US
Mailing Address - Phone:619-550-1555
Mailing Address - Fax:619-550-1888
Practice Address - Street 1:4226 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1503
Practice Address - Country:US
Practice Address - Phone:619-550-1555
Practice Address - Fax:619-550-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18279K1344600000X
CA63669G1343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi