Healthcare Provider Details

I. General information

NPI: 1063772036
Provider Name (Legal Business Name): NOVA SLEEP LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17404 HORACE ST
GRANADA HILLS CA
91344
US

IV. Provider business mailing address

17404 HORACE ST
GRANADA HILLS CA
91344
US

V. Phone/Fax

Practice location:
  • Phone: 818-497-3476
  • Fax:
Mailing address:
  • Phone: 818-497-3476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA ALEKSANYAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-497-3476