Healthcare Provider Details

I. General information

NPI: 1891575726
Provider Name (Legal Business Name): ALPHA MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W LEXINGTON DR # L100B
GLENDALE CA
91203-2230
US

IV. Provider business mailing address

121 W LEXINGTON DR # L100B
GLENDALE CA
91203-2230
US

V. Phone/Fax

Practice location:
  • Phone: 818-535-2151
  • Fax:
Mailing address:
  • Phone: 818-535-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. VARDAN MKHITARYAN
Title or Position: OWNER
Credential:
Phone: 818-535-2151