Provider Demographics
NPI:1447912381
Name:LAVISH TRANSPORTATION LLC
Entity type:Organization
Organization Name:LAVISH TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDURAHMAN
Authorized Official - Middle Name:AIDARUS
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-214-7505
Mailing Address - Street 1:3468 CITRUS ST STE I
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1503
Mailing Address - Country:US
Mailing Address - Phone:917-214-7505
Mailing Address - Fax:
Practice Address - Street 1:458 GRAND AVE APT A
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-5930
Practice Address - Country:US
Practice Address - Phone:917-214-7505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date: