Healthcare Provider Details

I. General information

NPI: 1801439138
Provider Name (Legal Business Name): AMERICAN GROUND TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1767 N BATAVIA ST
ORANGE CA
92865-4103
US

IV. Provider business mailing address

751 S WEIR CANYON RD STE 157-160
ANAHEIM CA
92808-1962
US

V. Phone/Fax

Practice location:
  • Phone: 714-279-0192
  • Fax: 714-279-9652
Mailing address:
  • Phone: 714-279-0192
  • Fax: 714-279-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. KONSTANTINOS RODITIS
Title or Position: CEO/MANAGING MEMBER
Credential:
Phone: 714-279-0192