Provider Demographics
NPI:1275618811
Name:QUALIUM CORP
Entity type:Organization
Organization Name:QUALIUM CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANOOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTOWFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-499-7597
Mailing Address - Street 1:14981 NATIONAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2600
Mailing Address - Country:US
Mailing Address - Phone:866-887-6673
Mailing Address - Fax:408-358-7753
Practice Address - Street 1:14981 NATIONAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2600
Practice Address - Country:US
Practice Address - Phone:866-887-6673
Practice Address - Fax:408-358-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06310ZOtherBLUE SHIELD ID#
CA7383382OtherAETNA ID#
CAZZZ06076ZOtherBLUE SHIELD ID# - DME
CAP00310625OtherRAILROAD MEDICARE ID#
CAZZZ03726ZOtherBLUE SHIELD ID#
CAZZZ25367ZMedicare ID - Type UnspecifiedMEDICARE
CA7383382OtherAETNA ID#