1508095522 NPI number — PACIFIC SLEEP MEDICINE SERVICES, 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 1508095522 NPI number — PACIFIC SLEEP MEDICINE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC 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:
1508095522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10532 ACACIA ST
Provider Second Line Business Mailing Address:
SUITE B-4
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-5446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-481-2577
Provider Business Mailing Address Fax Number:
909-481-2546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 1037
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-293-0874
Provider Business Practice Location Address Fax Number:
619-293-0874
Provider Enumeration Date:
07/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
951-284-5515

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com