Provider Demographics
NPI:1407808579
Name:PENINSULA SLEEP CENTER INC
Entity Type:Organization
Organization Name:PENINSULA SLEEP CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARID-MOAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-696-2415
Mailing Address - Street 1:1720 EL CAMINO REAL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3224
Mailing Address - Country:US
Mailing Address - Phone:650-696-2415
Mailing Address - Fax:650-696-2417
Practice Address - Street 1:1720 EL CAMINO REAL
Practice Address - Street 2:SUITE 150
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3224
Practice Address - Country:US
Practice Address - Phone:650-697-7079
Practice Address - Fax:650-697-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01601ZMedicare ID - Type UnspecifiedPROVIDER #