Healthcare Provider Details

I. General information

NPI: 1992134951
Provider Name (Legal Business Name): TITAN MEDICAL TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2013
Last Update Date: 11/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21201 KITTRIDGE ST APT 1307
WOODLAND HILLS CA
91303-5004
US

IV. Provider business mailing address

21201 KITTRIDGE ST APT 1307
WOODLAND HILLS CA
91303-5004
US

V. Phone/Fax

Practice location:
  • Phone: 818-731-0043
  • Fax:
Mailing address:
  • Phone: 818-731-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberD1142583
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberD1142583
License Number StateCA

VIII. Authorized Official

Name: MR. ROBERT SAMVELYAN
Title or Position: SECRETARY
Credential: S.T
Phone: 818-731-0043