Provider Demographics
NPI:1447615638
Name:EXPRESS TRANSPORTATION AGENCY
Entity Type:Organization
Organization Name:EXPRESS TRANSPORTATION AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIYELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-452-5262
Mailing Address - Street 1:10032 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2304
Mailing Address - Country:US
Mailing Address - Phone:818-452-5262
Mailing Address - Fax:
Practice Address - Street 1:10032 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2304
Practice Address - Country:US
Practice Address - Phone:818-452-5262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)