Provider Demographics
NPI:1295097962
Name:ADVANTA AMBULANCE, INC
Entity type:Organization
Organization Name:ADVANTA AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGAN-AKOPNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-957-3466
Mailing Address - Street 1:18034 VENTURA BLVD
Mailing Address - Street 2:267
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3516
Mailing Address - Country:US
Mailing Address - Phone:877-957-3466
Mailing Address - Fax:877-729-6131
Practice Address - Street 1:18034 VENTURA BLVD
Practice Address - Street 2:267
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3516
Practice Address - Country:US
Practice Address - Phone:877-957-3466
Practice Address - Fax:877-729-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)