Provider Demographics
NPI:1881867075
Name:ELJEAN LLC
Entity type:Organization
Organization Name:ELJEAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:VILLAPANDO
Authorized Official - Last Name:OSUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-452-8883
Mailing Address - Street 1:6540 LUSK BLVD
Mailing Address - Street 2:SUITE 138 C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2766
Mailing Address - Country:US
Mailing Address - Phone:858-452-8883
Mailing Address - Fax:858-452-8881
Practice Address - Street 1:6540 LUSK BLVD
Practice Address - Street 2:STE 138 C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2766
Practice Address - Country:US
Practice Address - Phone:858-452-8883
Practice Address - Fax:858-452-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)