Provider Demographics
NPI:1336553072
Name:MAGIC TRIP INC
Entity type:Organization
Organization Name:MAGIC TRIP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEBO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-245-6623
Mailing Address - Street 1:314 E BROADWAY
Mailing Address - Street 2:UNIT H
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1043
Mailing Address - Country:US
Mailing Address - Phone:818-245-6623
Mailing Address - Fax:818-245-6624
Practice Address - Street 1:314 E BROADWAY
Practice Address - Street 2:UNIT H
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1043
Practice Address - Country:US
Practice Address - Phone:818-245-6623
Practice Address - Fax:818-245-6624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)