Provider Demographics
NPI:1790874634
Name:STAR MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:STAR MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NIKOLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-353-8133
Mailing Address - Street 1:235 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1903
Mailing Address - Country:US
Mailing Address - Phone:626-390-2522
Mailing Address - Fax:
Practice Address - Street 1:7631 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2118
Practice Address - Country:US
Practice Address - Phone:818-353-8133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies