1427363258 NPI number — PACIFIC SLEEP MEDICAL GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427363258 NPI number — PACIFIC SLEEP MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC SLEEP MEDICAL GROUP, 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:
1427363258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUENA PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90622-6567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-995-5400
Provider Business Mailing Address Fax Number:
714-995-5254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 LINCOLN AVE.
Provider Second Line Business Practice Location Address:
205
Provider Business Practice Location Address City Name:
BUENA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90620-4164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-345-9858
Provider Business Practice Location Address Fax Number:
714-827-2874
Provider Enumeration Date:
08/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFMAN
Authorized Official First Name:
SIM
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
714-995-5400

Provider Taxonomy Codes

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

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





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