Provider Demographics
NPI:1285292813
Name:VITALINE TRANS, INC.
Entity type:Organization
Organization Name:VITALINE TRANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MKHITARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-861-2757
Mailing Address - Street 1:10331 LINDLEY AVE UNIT 223
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3595
Mailing Address - Country:US
Mailing Address - Phone:650-695-2960
Mailing Address - Fax:
Practice Address - Street 1:20 HAROLD AVE # C2
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-2067
Practice Address - Country:US
Practice Address - Phone:650-861-2757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)