Provider Demographics
NPI:1922212950
Name:VICTORVILLE MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:VICTORVILLE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBARDZUMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-951-1900
Mailing Address - Street 1:15159 PALMDALE RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2547
Mailing Address - Country:US
Mailing Address - Phone:760-951-1900
Mailing Address - Fax:760-951-1922
Practice Address - Street 1:15159 PALMDALE RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2547
Practice Address - Country:US
Practice Address - Phone:760-951-1900
Practice Address - Fax:760-951-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01228FMedicaid