Provider Demographics
NPI:1366942666
Name:ANGEL WINGS MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:ANGEL WINGS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOVANES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TER-ZAKARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-645-5686
Mailing Address - Street 1:1130 WEST OLIVE AVE.
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506
Mailing Address - Country:US
Mailing Address - Phone:818-645-5686
Mailing Address - Fax:323-668-0955
Practice Address - Street 1:1130 WEST OLIVE AVE.
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506
Practice Address - Country:US
Practice Address - Phone:818-645-5686
Practice Address - Fax:323-668-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care