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General NPI Number Information
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NPI Number | 1861421729
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Entity Type | Organization
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Legal Business Name | MEDTRANS
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 11490 BURBANK BLVD, #4E
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601
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Country | US
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Telephone | 818-783-4670
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Fax | 818-986-4628
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Provider Business Mailing Address
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Address Line | 14560 CLARK ST, #201
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City | SHERMAN OAKS
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State | CA
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Zip | 91411
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Country | US
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Telephone | 818-468-7922
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. IGOR BELOBORODOV
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Credential |
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Telephone | 818-468-7922
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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 | 64225484
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License Number State | CA
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