MEDICARE: PROFESSIONAL EXECUTIVE BUSINESS SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1053198044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL EXECUTIVE BUSINESS SERVICES, INC.

Provider Business Mailing Address
First Line	:	12304 SANTA MONICA BLVD STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2593
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12304 SANTA MONICA BLVD STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2593
Country	:	US
Telephone Number	:	818-395-3233
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ARMEN ARSHAKYAN
Credential	:
Telephone Number	:	818-395-3233

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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