Provider Demographics
NPI:1972831402
Name:GLENDALE SLEEP DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:GLENDALE SLEEP DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEVORG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUTAFYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-543-3000
Mailing Address - Street 1:800 S CENTRAL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4370
Mailing Address - Country:US
Mailing Address - Phone:818-543-3000
Mailing Address - Fax:818-543-3002
Practice Address - Street 1:800 S CENTRAL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-543-3000
Practice Address - Fax:818-543-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic