MEDICARE: SEVADA ANTONYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1043878275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEVADA ANTONYAN

Provider Business Mailing Address
First Line	:	1154 NORTON AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2029
Country	:	US
Telephone Number	:	818-439-0165
Fax Number	:

Provider Business Practice Location Address
First Line	:	1154 NORTON AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2029
Country	:	US
Telephone Number	:	818-439-0165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/03/2019

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Directions to “ SEVADA ANTONYAN ” Practice Location

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