Healthcare Provider Details

I. General information

NPI: 1295097962
Provider Name (Legal Business Name): ADVANTA AMBULANCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18034 VENTURA BLVD 267
ENCINO CA
91316-3516
US

IV. Provider business mailing address

18034 VENTURA BLVD 267
ENCINO CA
91316-3516
US

V. Phone/Fax

Practice location:
  • Phone: 877-957-3466
  • Fax: 877-729-6131
Mailing address:
  • Phone: 877-957-3466
  • Fax: 877-729-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARINA KOGAN-AKOPNIK
Title or Position: CEO
Credential:
Phone: 877-957-3466