Provider Demographics
NPI:1558511618
Name:MEDTRANS INC
Entity Type:Organization
Organization Name:MEDTRANS INC
Other - Org Name:MEDTRANS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:AVETISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-317-0178
Mailing Address - Street 1:345 S WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1941
Mailing Address - Country:US
Mailing Address - Phone:323-888-7750
Mailing Address - Fax:
Practice Address - Street 1:345 S WOODS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1941
Practice Address - Country:US
Practice Address - Phone:323-888-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
CAC04479652343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA482902OtherMEDICARE NORCAL
CACB378164OtherMEDICARE SOCAL