Provider Demographics
NPI:1790119840
Name:NUWAVE MEDICAL DIAGNOSTICS
Entity Type:Organization
Organization Name:NUWAVE MEDICAL DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-582-9576
Mailing Address - Street 1:11856 BALBOA BLVD
Mailing Address - Street 2:SUITE 141
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2753
Mailing Address - Country:US
Mailing Address - Phone:818-582-9576
Mailing Address - Fax:206-338-6100
Practice Address - Street 1:11856 BALBOA BLVD
Practice Address - Street 2:SUITE 141
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-2753
Practice Address - Country:US
Practice Address - Phone:818-582-9576
Practice Address - Fax:206-338-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic