Provider Demographics
NPI:1083887806
Name:BURBANK SLEEP TECHNOLOGY
Entity Type:Organization
Organization Name:BURBANK SLEEP TECHNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-984-6949
Mailing Address - Street 1:421 E ANGELENO AVE
Mailing Address - Street 2:STE: 206
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2286
Mailing Address - Country:US
Mailing Address - Phone:310-984-6949
Mailing Address - Fax:323-290-3846
Practice Address - Street 1:311 N ROBERTSON BLVD
Practice Address - Street 2:STE: 609
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1705
Practice Address - Country:US
Practice Address - Phone:310-984-6949
Practice Address - Fax:323-290-3846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36302173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty