MEDICARE: SOCAL SLEEP CENTERS LLC

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	:	1619265048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOCAL SLEEP CENTERS LLC

Provider Business Mailing Address
First Line	:	6320A WISLHIRE BLVD 1114
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6320A WISLHIRE BLVD 1114
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048
Country	:	US
Telephone Number	:	310-230-5741
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CHARLES KLASKY
Credential	:
Telephone Number	:	310-230-5741

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/19/2011

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