MEDICARE: CA EXPRESS

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)	D2281336	CA

General Provider Information

NPI Number	:	1578977013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CA EXPRESS

Provider Business Mailing Address
First Line	:	1523 N MARIPOSA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5101
Country	:	US
Telephone Number	:	213-361-4373
Fax Number	:	323-644-5404

Provider Business Practice Location Address
First Line	:	1523 N MARIPOSA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5101
Country	:	US
Telephone Number	:	213-361-4373
Fax Number	:	323-644-5404

Authorized Official
Title or Position	:	OWNER
Name	:	GEVORG DIARYAN
Credential	:
Telephone Number	:	213-361-4373

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	06/12/2014

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Directions to “CA EXPRESS ” Practice Location

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