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General NPI Number Information
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NPI Number | 1295097962
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Entity Type | Organization
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Legal Business Name | ADVANTA AMBULANCE, INC
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 18034 VENTURA BLVD 267
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City | ENCINO
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State | CA
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Zip | 91316-3516
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Country | US
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Telephone | 877-957-3466
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Fax | 877-729-6131
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Provider Business Mailing Address
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Address Line | 18034 VENTURA BLVD 267
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City | ENCINO
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State | CA
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Zip | 91316-3516
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Country | US
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Telephone | 877-957-3466
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Fax | 877-729-6131
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Authorized Official
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Title or Position | CEO
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Name | MRS. MARINA KOGAN-AKOPNIK
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Credential |
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Telephone | 877-957-3466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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