Healthcare Provider Details

I. General information

NPI: 1134895097
Provider Name (Legal Business Name): AASTA HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GARRITY BLVD SUITE 103
NAMPA ID
83687
US

IV. Provider business mailing address

19350 BUSINESS CENTER DR SUITE 200
NORTHRIDGE CA
91324-1828
US

V. Phone/Fax

Practice location:
  • Phone: 818-317-9565
  • Fax:
Mailing address:
  • Phone: 818-317-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NARINDER KUMAR
Title or Position: CEO
Credential:
Phone: 818-317-9695