Provider Demographics
NPI:1710237920
Name:QUALIUM CORP
Entity Type:Organization
Organization Name:QUALIUM CORP
Other - Org Name:BAY SLEEP CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANOOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTOWFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-499-7597
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 1:3121 PARK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2920
Practice Address - Country:US
Practice Address - Phone:831-600-7890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUALIUM CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic