1730268467 NPI number — PACIFIC SLEEP MEDICINE, A MEDICAL CORPORATION

Table of content: (NPI 1730268467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730268467 NPI number — PACIFIC SLEEP MEDICINE, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC SLEEP MEDICINE, A MEDICAL CORPORATION
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:
1730268467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 E OLIVE AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-5255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-793-9190
Provider Business Mailing Address Fax Number:
909-793-9770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6333 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
STE 402
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-5702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-782-9894
Provider Business Practice Location Address Fax Number:
323-782-0687
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOJORQUEZ
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
909-793-9190

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)

  • Identifier: 290011197 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DD511Y . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FG622Z . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com