Provider Demographics
NPI:1972313948
Name:PACIFIC RIDE MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:PACIFIC RIDE MEDICAL TRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEONICA
Authorized Official - Middle Name:MILLERA
Authorized Official - Last Name:CARURUCAN
Authorized Official - Suffix:
Authorized Official - Credentials:TRANSPORTATION
Authorized Official - Phone:818-813-4978
Mailing Address - Street 1:12621 WIXOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2146
Mailing Address - Country:US
Mailing Address - Phone:818-813-4978
Mailing Address - Fax:818-853-7001
Practice Address - Street 1:14416 VICTORY BLVD STE 239
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1441
Practice Address - Country:US
Practice Address - Phone:818-813-4978
Practice Address - Fax:818-853-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)