MEDICARE: OLIVE SLEEP & EEG 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1518387760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE SLEEP & EEG INC

Provider Business Mailing Address
First Line	:	931 W OLIVE AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2209
Country	:	US
Telephone Number	:	818-848-6688
Fax Number	:	818-846-6689

Provider Business Practice Location Address
First Line	:	931 W OLIVE AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2209
Country	:	US
Telephone Number	:	818-848-6688
Fax Number	:	818-846-6689

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MARIAM UNJUGHULYAN
Credential	:
Telephone Number	:	818-848-6688

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	04/29/2014

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