Provider Demographics
NPI:1699963512
Name:STARLIGHT SLEEP CENTER INC
Entity type:Organization
Organization Name:STARLIGHT SLEEP CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTAFYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-833-9194
Mailing Address - Street 1:5010 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5820
Mailing Address - Country:US
Mailing Address - Phone:323-660-5040
Mailing Address - Fax:323-660-5041
Practice Address - Street 1:5010 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5820
Practice Address - Country:US
Practice Address - Phone:323-660-5040
Practice Address - Fax:323-660-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABB841Medicare PIN