Organization
GOLDEN AGE MEDICAL TRANSPORTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GRIGORY BRAVERMAN (GENERAL PARTNER)
(323) 333-5383
Entity
Organization
Contact information
Practice address
11110 RED CEDAR DR, SAN DIEGO, CA 92131-1310
(858) 689-9770
(619) 337-1499
Mailing address
11110 RED CEDAR DR, SAN DIEGO, CA 92131-1310
(858) 689-9770
(619) 337-1499
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
643533-92
CA
343900000X
Non-emergency Medical Transport (VAN)
Primary
64353392
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MTN01191F
—
CA
Enumeration date
02/11/2007
Last updated
04/07/2014
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