Healthcare Provider Details

I. General information

NPI: 1134088479
Provider Name (Legal Business Name): ASTRA LIFE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N CENTRAL AVE STE 208
GLENDALE CA
91202-2937
US

IV. Provider business mailing address

1010 N CENTRAL AVE STE 208
GLENDALE CA
91202-2937
US

V. Phone/Fax

Practice location:
  • Phone: 747-477-1977
  • Fax: 276-296-5735
Mailing address:
  • Phone: 747-477-1977
  • Fax: 276-296-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KHACHYK AVETISOV
Title or Position: CEO
Credential:
Phone: 818-612-5394