MEDICARE: OPTIMAL SLEEP, LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1518342203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL SLEEP, LLC

Provider Business Mailing Address
First Line	:	215 N. MARENGO AVE
Second Line	:	SUITE 110
City	:	PASADENA
State	:	CA
Zip	:	91101-1563
Country	:	US
Telephone Number	:	626-600-5666
Fax Number	:	855-649-7005

Provider Business Practice Location Address
First Line	:	215 N MARENGO AVE
Second Line	:	SUITE 110
City	:	PASADENA
State	:	CA
Zip	:	91101-1503
Country	:	US
Telephone Number	:	626-600-5666
Fax Number	:	626-410-6686

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ARUSYAK KHACHATRYAN
Credential	:
Telephone Number	:	626-600-5666

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	09/14/2017

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