Healthcare Provider Details

I. General information

NPI: 1447584586
Provider Name (Legal Business Name): WELLCARE SLEEP CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23600 TELO AVE SUITE150
TORRANCE CA
90505-4035
US

IV. Provider business mailing address

23600 TELO AVE SUITE150
TORRANCE CA
90505-4035
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-3084
  • Fax: 310-602-5001
Mailing address:
  • Phone: 310-325-3084
  • Fax: 310-602-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SASAN NICKBAKHT
Title or Position: PRESIDENT
Credential:
Phone: 310-325-3084