MEDICARE: ASTRA LIFE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1134088479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTRA LIFE INC

Provider Business Mailing Address
First Line	:	1010 N CENTRAL AVE STE 208
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2937
Country	:	US
Telephone Number	:	747-477-1977
Fax Number	:	276-296-5735

Provider Business Practice Location Address
First Line	:	1010 N CENTRAL AVE STE 208
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2937
Country	:	US
Telephone Number	:	747-477-1977
Fax Number	:	276-296-5735

Authorized Official
Title or Position	:	CEO
Name	:	KHACHYK AVETISOV
Credential	:
Telephone Number	:	818-612-5394

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	04/07/2026

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