Healthcare Provider Details

I. General information

NPI: 1750227906
Provider Name (Legal Business Name): ACTIVE WAY TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 TANNENCREST DR
DUARTE CA
91010-1673
US

IV. Provider business mailing address

3318 TANNENCREST DR
DUARTE CA
91010-1673
US

V. Phone/Fax

Practice location:
  • Phone: 626-706-6304
  • Fax:
Mailing address:
  • Phone: 626-706-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: VARDGES BADALYAN
Title or Position: CEO
Credential:
Phone: 626-706-6304