=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215170469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASTER SLEEP INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2009
-----------------------------------------------------
Last Update Date | 04/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4533 VAN NUYS BLVD STE 302
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-2950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-849-6755
-----------------------------------------------------
Fax | 818-849-6754
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4533 VAN NUYS BLVD STE 302
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-2950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-849-6755
-----------------------------------------------------
Fax | 818-849-6754
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. LUCIEN KROYTOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-849-6755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QS1201X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------