1952020422 NPI number — CENTURION MEDICAL TRANSPORT LLC

Table of content: DR. MEHRAN MARY CHITGAR DMD (NPI 1760628432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952020422 NPI number — CENTURION MEDICAL TRANSPORT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTURION MEDICAL TRANSPORT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952020422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3630 HIGH ST
Provider Second Line Business Mailing Address:
#19069
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-467-2109
Provider Business Mailing Address Fax Number:
650-547-6163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1516 OAK ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-467-2109
Provider Business Practice Location Address Fax Number:
650-547-6163
Provider Enumeration Date:
08/26/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MAHER
Authorized Official First Name:
EMERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
510-467-2109

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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