=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437450590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELIANCE MEDICAL TRANSPORT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2010
-----------------------------------------------------
Last Update Date | 11/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2829 N SAN FERNANDO RD SUITE 210
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90065-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-344-8800
-----------------------------------------------------
Fax | 323-344-8808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2829 N SAN FERNANDO RD SUITE 210
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90065-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-344-8800
-----------------------------------------------------
Fax | 323-344-8808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | VAHE KAZARYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-344-8800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 8V69422
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------