Provider Demographics
NPI:1326231101
Name:5 STAR MEDICAL RESPONSE
Entity Type:Organization
Organization Name:5 STAR MEDICAL RESPONSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:BALSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-802-8438
Mailing Address - Street 1:7336 SANTA MONICA BLVD #819
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6616
Mailing Address - Country:US
Mailing Address - Phone:818-802-8438
Mailing Address - Fax:323-882-6427
Practice Address - Street 1:2510 S GRAND AVE # B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2651
Practice Address - Country:US
Practice Address - Phone:818-802-8438
Practice Address - Fax:323-882-6427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000211972400018343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)