Provider Demographics
NPI:1689297640
Name:BLUE ANGELS TRANS LLC
Entity Type:Organization
Organization Name:BLUE ANGELS TRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VARDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-717-6218
Mailing Address - Street 1:3330 SPANNA CT/
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-717-6218
Mailing Address - Fax:
Practice Address - Street 1:11082 COLOMA RD. SUITE #10
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-717-6218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE ANGELS TRANS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)