Provider Demographics
NPI:1861472128
Name:MOONLIGHT SLEEP LABS, LLC
Entity Type:Organization
Organization Name:MOONLIGHT SLEEP LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASKHOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-385-0077
Mailing Address - Street 1:5363 BALBOA BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2805
Mailing Address - Country:US
Mailing Address - Phone:818-385-0077
Mailing Address - Fax:818-385-0987
Practice Address - Street 1:5363 BALBOA BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2805
Practice Address - Country:US
Practice Address - Phone:818-385-0077
Practice Address - Fax:818-385-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIDTF00310Medicaid
CAZZZ08189ZOtherBLUE SHIELD
CAIDTF00310Medicaid
CAY16510Medicare UPIN