MEDICARE: QUALIUM CORP.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ06310Z	OTHER	CA	BLUE SHIELD ID#
2	7383382	OTHER	CA	AETNA ID#
3	ZZZ06076Z	OTHER	CA	BLUE SHIELD ID# - DME

General Provider Information

NPI Number	:	1508910928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALIUM CORP.

Provider Business Mailing Address
First Line	:	14981 NATIONAL AVE
Second Line	:	SUITE 1
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2600
Country	:	US
Telephone Number	:	866-887-6673
Fax Number	:	866-442-7632

Provider Business Practice Location Address
First Line	:	1375 SUTTER ST
Second Line	:	SUITE 216
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-5438
Country	:	US
Telephone Number	:	415-563-7773
Fax Number	:	415-563-7753

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANOOSH MOSTOWFI
Credential	:
Telephone Number	:	408-499-7597

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	09/10/2010

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Directions to “QUALIUM CORP. ” Practice Location

Language	Start Address	Practice Location

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