Provider Demographics
NPI:1679014336
Name:SOCAL MED
Entity Type:Organization
Organization Name:SOCAL MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TSATURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-272-2826
Mailing Address - Street 1:312 E PALMER AVE # K
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5633
Mailing Address - Country:US
Mailing Address - Phone:747-272-2826
Mailing Address - Fax:
Practice Address - Street 1:312 E PALMER AVE # K
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5633
Practice Address - Country:US
Practice Address - Phone:747-272-2826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)