Healthcare Provider Details

I. General information

NPI: 1568544534
Provider Name (Legal Business Name): MAGTRANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 VENICE BLVD
LOS ANGELES CA
90006-5222
US

IV. Provider business mailing address

2065 VENICE BLVD
LOS ANGELES CA
90006-5222
US

V. Phone/Fax

Practice location:
  • Phone: 323-851-9100
  • Fax: 323-766-0900
Mailing address:
  • Phone: 323-851-9100
  • Fax: 323-766-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberMTN01156F
License Number StateCA

VIII. Authorized Official

Name: BRIDGETTE POVOLOTSKY
Title or Position: PRESIDENT
Credential:
Phone: 323-851-9100