Organization
PENTA STAR INC
Active
Other names
Eagle Wings Medical Transportation
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRANIK TATEVOSIAN (CHIEF FINANCIAL OFFICER)
(818) 550-8150
Entity
Organization
Contact information
Practice address
204 E CHEVY CHASE DR # 5, GLENDALE, CA 91205-3178
(818) 550-8150
(818) 550-8160
Mailing address
204 E CHEVY CHASE DR # 5, GLENDALE, CA 91205-3178
(818) 550-8150
(818) 550-8160
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTN01231F
MEDICAL
CA
Enumeration date
05/16/2007
Last updated
05/28/2009
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