Provider Demographics
NPI:1790041432
Name:GM MEDLINE
Entity Type:Organization
Organization Name:GM MEDLINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MELKONYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-320-1933
Mailing Address - Street 1:716 N VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:716 N VALLEY ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3829
Practice Address - Country:US
Practice Address - Phone:323-320-1933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201102951341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance