MEDICARE: CARE SLEEP CLINIC INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1093319873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE SLEEP CLINIC INC.

Provider Business Mailing Address
First Line	:	1027 CORVETTE DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-2904
Country	:	US
Telephone Number	:	408-835-8213
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 GRAVES AVE STE 11F
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-5014
Country	:	US
Telephone Number	:	408-930-5238
Fax Number	:	408-564-7468

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LUBNA AZEEM
Credential	:	DDS
Telephone Number	:	408-835-8213

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	12/08/2020

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