Provider Demographics
NPI:1588843817
Name:SOUTH COAST MEDICAL TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:SOUTH COAST MEDICAL TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YURI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBARDZUMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-247-8239
Mailing Address - Street 1:415 E HARVARD ST
Mailing Address - Street 2:201
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1057
Mailing Address - Country:US
Mailing Address - Phone:818-247-8239
Mailing Address - Fax:818-247-8233
Practice Address - Street 1:415 E HARVARD ST
Practice Address - Street 2:201
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1057
Practice Address - Country:US
Practice Address - Phone:818-247-8239
Practice Address - Fax:818-247-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-03
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN01267F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01267FMedicaid