Provider Demographics
NPI:1144419730
Name:UNIVERSAL MEDICAL TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL TRANSPORTATION, INC.
Other - Org Name:SUNNY MEDICAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMUR
Authorized Official - Middle Name:
Authorized Official - Last Name:RADZHABOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-559-0888
Mailing Address - Street 1:212 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2408
Mailing Address - Country:US
Mailing Address - Phone:310-559-0888
Mailing Address - Fax:310-559-1568
Practice Address - Street 1:3739 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6311
Practice Address - Country:US
Practice Address - Phone:310-559-0888
Practice Address - Fax:310-559-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000121902-0001-7343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01137FMedicaid