Organization
MOONLIGHT SLEEP LABS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ERIKA PASKHOVER (CLINICAL DIRECTOR)
(818) 385-0077
Entity
Organization
Contact information
Practice address
5363 BALBOA BLVD, SUITE 121, ENCINO, CA 91316-2805
(818) 385-0077
(818) 385-0987
Mailing address
5363 BALBOA BLVD, SUITE 121, ENCINO, CA 91316-2805
(818) 385-0077
(818) 385-0987
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTF00310
—
CA
01
—
ZZZ08189Z
BLUE SHIELD
CA
Enumeration date
01/20/2006
Last updated
10/21/2008
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