Healthcare Provider Details

I. General information

NPI: 1801373469
Provider Name (Legal Business Name): LUCKY RIDERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 WILLIAMS ST STE 310
SIMI VALLEY CA
93065-7842
US

IV. Provider business mailing address

1919 WILLIAMS ST STE 310
SIMI VALLEY CA
93065-7842
US

V. Phone/Fax

Practice location:
  • Phone: 818-489-2719
  • Fax:
Mailing address:
  • Phone: 818-619-6591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IVAN LAURITZEN
Title or Position: PRESIDENT
Credential:
Phone: 818-489-2719