MEDICARE: QUALIUM CORP

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	:	1710237920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALIUM CORP

Provider Business Mailing Address
First Line	:	1845 WINCHESTER BLVD
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-1165
Country	:	US
Telephone Number	:	866-887-6673
Fax Number	:	866-442-7632

Provider Business Practice Location Address
First Line	:	3121 PARK AVE
Second Line	:	SUITE C
City	:	SOQUEL
State	:	CA
Zip	:	95073-2920
Country	:	US
Telephone Number	:	831-600-7890
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANOOSH MOSTOWFI
Credential	:
Telephone Number	:	408-499-7597

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	09/14/2012

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