MEDICARE: MEDTRANS INC

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	341600000X	Ambulance
2	343900000X	Non-emergency Medical Transport (VAN)	C04479652	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA482902	OTHER	CA	MEDICARE NORCAL
2	CB378164	OTHER	CA	MEDICARE SOCAL

General Provider Information

NPI Number	:	1558511618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTRANS INC

Provider Business Mailing Address
First Line	:	345 S WOODS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1941
Country	:	US
Telephone Number	:	323-888-7750
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 S WOODS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1941
Country	:	US
Telephone Number	:	323-888-7750
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PETER AVETISYAN
Credential	:
Telephone Number	:	323-317-0178

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	10/15/2021

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Directions to “MEDTRANS INC ” Practice Location

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