1154573616 NPI number — ADVANCED SLEEP MEDICINE SERVICES INC

Table of content: (NPI 1154573616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154573616 NPI number — ADVANCED SLEEP MEDICINE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SLEEP MEDICINE SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154573616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17835 VENTURA BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91316-3677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-775-3377
Provider Business Mailing Address Fax Number:
877-855-6227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23961 CALLE DE LA MAGDALENA
Provider Second Line Business Practice Location Address:
SUITE 519
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-7622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-775-3377
Provider Business Practice Location Address Fax Number:
877-855-6227
Provider Enumeration Date:
10/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
KERMIT
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
CEO/ PRESIDENT
Authorized Official Telephone Number:
877-775-3377

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)