Provider Demographics
NPI:1437280187
Name:PIONEER TRANSPORTATION, INC
Entity Type:Organization
Organization Name:PIONEER TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-466-6253
Mailing Address - Street 1:13812 SATICOY ST STE C
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6568
Mailing Address - Country:US
Mailing Address - Phone:323-466-6253
Mailing Address - Fax:866-301-3548
Practice Address - Street 1:13812 SATICOY ST STE C
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-6568
Practice Address - Country:US
Practice Address - Phone:323-466-6253
Practice Address - Fax:866-301-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN01134F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01134FMedicaid