Organization
PENTA STAR INC
Active
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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