Provider Demographics
NPI:1962952861
Name:DOMINION TRANSPORTATION
Entity type:Organization
Organization Name:DOMINION TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:TEMIDAYO
Authorized Official - Last Name:OLOWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-236-2127
Mailing Address - Street 1:1136 N YUCCA AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3223
Mailing Address - Country:US
Mailing Address - Phone:909-236-2127
Mailing Address - Fax:
Practice Address - Street 1:1136 N YUCCA AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3223
Practice Address - Country:US
Practice Address - Phone:909-236-2127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1605376343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)