Provider Demographics
NPI:1447584586
Name:WELLCARE SLEEP CENTER INC
Entity Type:Organization
Organization Name:WELLCARE SLEEP CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKBAKHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-325-3084
Mailing Address - Street 1:23600 TELO AVE
Mailing Address - Street 2:SUITE150
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4035
Mailing Address - Country:US
Mailing Address - Phone:310-325-3084
Mailing Address - Fax:310-602-5001
Practice Address - Street 1:23600 TELO AVE
Practice Address - Street 2:SUITE150
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4035
Practice Address - Country:US
Practice Address - Phone:310-325-3084
Practice Address - Fax:310-602-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic