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General NPI Number Information
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NPI Number | 1487102935
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Entity Type | Organization
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Legal Business Name | CRYSTAL MEDICAL TRANSPORTATION,INC
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 8001 LAUREL CANYON BLVD STE 101
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City | N HOLLYWOOD
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State | CA
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Zip | 91605
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Country | US
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Telephone | 818-768-1312
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Fax | 818-768-1322
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Provider Business Mailing Address
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Address Line | 8001 LAUREL CANYON BLVD STE 101
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City | N HOLLYWOOD
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State | CA
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Zip | 91605-1458
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Country | US
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Telephone | 818-768-1312
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Fax | 818-768-1322
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISTINA DJANGOULIAN
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Credential |
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Telephone | 818-768-1312
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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 | PSG0036747
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License Number State | CA
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