Provider Demographics
NPI:1467153965
Name:-
Entity Type:Organization
Organization Name:-
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:PARSEK
Authorized Official - Last Name:ODABASHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-606-5655
Mailing Address - Street 1:14726 RAMONA AVE STE E8
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5730
Mailing Address - Country:US
Mailing Address - Phone:909-606-5655
Mailing Address - Fax:
Practice Address - Street 1:14726 RAMONA AVE STE E8
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5730
Practice Address - Country:US
Practice Address - Phone:909-606-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)