Provider Demographics
NPI:1487102935
Name:CRYSTAL MEDICAL TRANSPORTATION,INC
Entity type:Organization
Organization Name:CRYSTAL MEDICAL TRANSPORTATION,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DJANGOULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-768-1312
Mailing Address - Street 1:8001 LAUREL CANYON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1458
Mailing Address - Country:US
Mailing Address - Phone:818-768-1312
Mailing Address - Fax:818-768-1322
Practice Address - Street 1:8001 LAUREL CANYON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605
Practice Address - Country:US
Practice Address - Phone:818-768-1312
Practice Address - Fax:818-768-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSG0036747343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)