=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497176192
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NN TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2013
-----------------------------------------------------
Last Update Date | 12/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13132 HARTLAND ST
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91605-4739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-804-1674
-----------------------------------------------------
Fax | 818-243-3430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13132 HARTLAND ST
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91605-4739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-804-1674
-----------------------------------------------------
Fax | 818-243-3430
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANDRANIK ANDY DZHRDZHYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-804-1674
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------