Provider Demographics
NPI:1346916269
Name:CALSTATE MEDICAL
Entity Type:Organization
Organization Name:CALSTATE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GALUST
Authorized Official - Middle Name:GARRY
Authorized Official - Last Name:GHUMASHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-744-3436
Mailing Address - Street 1:10757 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2545
Mailing Address - Country:US
Mailing Address - Phone:818-744-3436
Mailing Address - Fax:
Practice Address - Street 1:2019 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3334
Practice Address - Country:US
Practice Address - Phone:818-744-3436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport