Provider Demographics
NPI:1215404116
Name:QUALIUM CORP.
Entity Type:Organization
Organization Name:QUALIUM CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:866-887-6673
Mailing Address - Street 1:1845 WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1165
Mailing Address - Country:US
Mailing Address - Phone:866-887-6673
Mailing Address - Fax:866-442-7632
Practice Address - Street 1:3421 VALLE VERDE DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2414
Practice Address - Country:US
Practice Address - Phone:866-887-6673
Practice Address - Fax:866-442-7632
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUALIUM CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic