Provider Demographics
NPI:1033695739
Name:ALTA MED MEDICAL TRANSPORTATION INC.
Entity Type:Organization
Organization Name:ALTA MED MEDICAL TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMURYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-800-8280
Mailing Address - Street 1:11012 VENTURA BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3546
Mailing Address - Country:US
Mailing Address - Phone:818-800-8280
Mailing Address - Fax:
Practice Address - Street 1:11012 VENTURA BLVD STE H
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3546
Practice Address - Country:US
Practice Address - Phone:818-800-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherMEDICAL TRANSPORTATION