MEDICARE: BRILLIANT AMBULANCE 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

General Provider Information

NPI Number	:	1568275188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILLIANT AMBULANCE INC

Provider Business Mailing Address
First Line	:	900 W GLENOAKS BLVD STE A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2664
Country	:	US
Telephone Number	:	818-373-9393
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W GLENOAKS BLVD STE A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2664
Country	:	US
Telephone Number	:	818-373-9393
Fax Number	:

Authorized Official
Title or Position	:	OPERATION MANAGER
Name	:	ALEN BABAKHANIANS
Credential	:
Telephone Number	:	818-373-9393

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/28/2025

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