Provider Demographics
NPI:1992225296
Name:P'OKOT LLC
Entity type:Organization
Organization Name:P'OKOT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LADYWINNIE
Authorized Official - Middle Name:AMOO
Authorized Official - Last Name:OULANYAH
Authorized Official - Suffix:
Authorized Official - Credentials:HIM
Authorized Official - Phone:619-578-8416
Mailing Address - Street 1:5511 ADELAIDE AVE UNIT 26
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5319
Mailing Address - Country:US
Mailing Address - Phone:619-578-8416
Mailing Address - Fax:
Practice Address - Street 1:5511 ADELAIDE AVE
Practice Address - Street 2:26
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115
Practice Address - Country:US
Practice Address - Phone:619-578-8416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2017005987343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)