Healthcare Provider Details

I. General information

NPI: 1659979292
Provider Name (Legal Business Name): 1800MEDIVAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15159 PALMDALE RD
VICTORVILLE CA
92392-2547
US

IV. Provider business mailing address

PO BOX 10848
GLENDALE CA
91209-3848
US

V. Phone/Fax

Practice location:
  • Phone: 747-200-0001
  • Fax:
Mailing address:
  • Phone: 747-200-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YURI HAMBARDZUMYAN
Title or Position: OWNER
Credential:
Phone: 747-200-0001