Organization
BR MEDIVAN INC.
Active
Other names
BR Medivan
Organization subpart
No
Provider details
NPI number
Authorized official
MARK RUIZ (PRESIDENT)
(925) 698-1207
Entity
Organization
Contact information
Practice address
2689 PRESIDIO DR, BRENTWOOD, CA 94513-5609
(925) 848-1715
(925) 392-8589
Mailing address
2689 PRESIDIO DR, BRENTWOOD, CA 94513-5609
(925) 848-1715
(925) 392-8589
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396436267
—
CA
Enumeration date
05/19/2023
Last updated
05/19/2023
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