MEDICARE: DOLCE VITA TRANSPORTATION, 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	:	1235557083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOLCE VITA TRANSPORTATION, INC

Provider Business Mailing Address
First Line	:	1208 N GOWER ST APT 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-1871
Country	:	US
Telephone Number	:	323-400-5591
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 N GOWER ST APT 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-1871
Country	:	US
Telephone Number	:	323-400-5591
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUREN VARDANYAN
Credential	:
Telephone Number	:	323-400-5591

Provider Enumeration Date	:	03/30/2014
Last Update Date	:	03/30/2014

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