Provider Demographics
NPI:1972732683
Name:SLEEP MED OF LA
Entity type:Organization
Organization Name:SLEEP MED OF LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKBAKHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-300-0022
Mailing Address - Street 1:18345 VENTURA BLVD
Mailing Address - Street 2:STE 403
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4232
Mailing Address - Country:US
Mailing Address - Phone:818-300-0022
Mailing Address - Fax:818-300-0021
Practice Address - Street 1:18345 VENTURA BLVD
Practice Address - Street 2:STE 403
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4232
Practice Address - Country:US
Practice Address - Phone:818-300-0022
Practice Address - Fax:818-300-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty