Provider Demographics
NPI:1811405046
Name:ROYAL MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:ROYAL MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVIKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-245-3136
Mailing Address - Street 1:3924 LA JOLLA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1416
Mailing Address - Country:US
Mailing Address - Phone:858-245-3136
Mailing Address - Fax:858-356-9600
Practice Address - Street 1:13543 ZINNIA HILLS PL APT 85
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-5769
Practice Address - Country:US
Practice Address - Phone:858-245-3136
Practice Address - Fax:858-245-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)