Healthcare Provider Details

I. General information

NPI: 1205282134
Provider Name (Legal Business Name): MADANYAN ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N CENTRAL AVE STE 214
GLENDALE CA
91203-4254
US

IV. Provider business mailing address

715 N CENTRAL AVE STE 214
GLENDALE CA
91203-4254
US

V. Phone/Fax

Practice location:
  • Phone: 818-461-2323
  • Fax:
Mailing address:
  • Phone: 818-461-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. AKOP S MADANYAN
Title or Position: C.E.O.
Credential:
Phone: 818-461-2323