Provider Demographics
NPI:1821512716
Name:WILBUR SLEEP CENTER
Entity Type:Organization
Organization Name:WILBUR SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-250-7620
Mailing Address - Street 1:18905 SHERMAN WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2600
Mailing Address - Country:US
Mailing Address - Phone:818-578-3240
Mailing Address - Fax:818-858-1803
Practice Address - Street 1:18905 SHERMAN WAY STE 200
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2600
Practice Address - Country:US
Practice Address - Phone:818-578-3240
Practice Address - Fax:818-858-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic