Provider Demographics
NPI:1235417395
Name:MAGLAMYAN, MANVEL
Entity Type:Individual
Prefix:
First Name:MANVEL
Middle Name:
Last Name:MAGLAMYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 N TAMERA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4042
Mailing Address - Country:US
Mailing Address - Phone:559-917-6292
Mailing Address - Fax:
Practice Address - Street 1:2016 H ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1026
Practice Address - Country:US
Practice Address - Phone:559-917-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408712343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)