Healthcare Provider Details

I. General information

NPI: 1740338045
Provider Name (Legal Business Name): MEDCARE MEDICAL TRANSPORTATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8531 LANKERSHIM BLVD STE B
SUN VALLEY CA
91352-3127
US

IV. Provider business mailing address

8531 LANKERSHIM BLVD STE B
SUN VALLEY CA
91352-3127
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-4572
  • Fax:
Mailing address:
  • Phone: 818-786-4572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMTN01053G
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name: PAVEL RASKIN
Title or Position: CEO
Credential:
Phone: 818-505-0846