Healthcare Provider Details

I. General information

NPI: 1679403117
Provider Name (Legal Business Name): ORIGIN TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 ORANGETHORPE AVE STE 170R
BUENA PARK CA
90620-1315
US

IV. Provider business mailing address

6131 ORANGETHORPE AVE STE 170R
BUENA PARK CA
90620-1315
US

V. Phone/Fax

Practice location:
  • Phone: 818-867-4446
  • Fax: 818-741-2186
Mailing address:
  • Phone: 818-867-4446
  • Fax: 818-741-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: REMY TOUTOUNJI
Title or Position: COO
Credential:
Phone: 818-661-7349