Provider Demographics
NPI:1376750117
Name:LAURELS MEDICAL SERVICES
Entity Type:Organization
Organization Name:LAURELS MEDICAL SERVICES
Other - Org Name:CHARIOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIR
Authorized Official - Middle Name:TARIQ
Authorized Official - Last Name:RIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-487-1111
Mailing Address - Street 1:4617 CARRIGAN LN
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2243
Mailing Address - Country:US
Mailing Address - Phone:916-487-1111
Mailing Address - Fax:916-484-3016
Practice Address - Street 1:4617 CARRIGAN LN
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2243
Practice Address - Country:US
Practice Address - Phone:916-487-1111
Practice Address - Fax:916-484-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126461343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01146FOtherMEDICAL PROVIDER NUMBER