Provider Demographics
NPI:1922152107
Name:QUALIUM CORP
Entity Type:Organization
Organization Name:QUALIUM CORP
Other - Org Name:BAY SLEEP CLINIC
Other - Org Type:Other Name
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 1:14981 NATIONAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2600
Mailing Address - Country:US
Mailing Address - Phone:866-887-6673
Mailing Address - Fax:866-442-7632
Practice Address - Street 1:830 MENLO AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4751
Practice Address - Country:US
Practice Address - Phone:866-887-6673
Practice Address - Fax:866-442-7632
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUALIUM CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7383382OtherAETNA ID#
CAZZZ09173ZOtherBLUE SHIELD ID#