MEDICARE: PENINSULA SLEEP CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1407808579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENINSULA SLEEP CENTER INC

Provider Business Mailing Address
First Line	:	1720 EL CAMINO REAL
Second Line	:	SUITE 150
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3224
Country	:	US
Telephone Number	:	650-696-2415
Fax Number	:	650-696-2417

Provider Business Practice Location Address
First Line	:	1720 EL CAMINO REAL
Second Line	:	SUITE 150
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3224
Country	:	US
Telephone Number	:	650-697-7079
Fax Number	:	650-697-5845

Authorized Official
Title or Position	:	CEO
Name	:	MEHRAN FARID-MOAYER
Credential	:	M.D.
Telephone Number	:	650-696-2415

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	05/16/2012

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Directions to “PENINSULA SLEEP CENTER INC ” Practice Location

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