MEDICARE: LA EXPRESS MEDICAL 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)	MTN01085F	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942305545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA EXPRESS MEDICAL TRANSPORTATION, INC

Provider Business Mailing Address
First Line	:	311 N ROBERTSON BLVD # 629
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1705
Country	:	US
Telephone Number	:	323-933-7456
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 S FAIRFAX AVE STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3148
Country	:	US
Telephone Number	:	323-933-7456
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK VINNITSKI
Credential	:
Telephone Number	:	323-933-7456

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/22/2020

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Directions to “LA EXPRESS MEDICAL TRANSPORTATION, INC ” Practice Location

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