MEDICARE: SLEEP CENTER OF SO ORANGE CTY

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	:	1427001353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP CENTER OF SO ORANGE CTY

Provider Business Mailing Address
First Line	:	27882 FORBES RD
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-1219
Country	:	US
Telephone Number	:	949-364-6600
Fax Number	:	949-364-7065

Provider Business Practice Location Address
First Line	:	9663 SANTA MONICA BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4303
Country	:	US
Telephone Number	:	949-364-6600
Fax Number	:	949-364-7065

Authorized Official
Title or Position	:	PARTNER
Name	:	ABRAHAM ISHAAYA
Credential	:	MD
Telephone Number	:	949-364-6600

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/22/2020

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