1861642472 NPI number — SLEEP DIAGNOSTIC CENTER OF RANCHO MIRAGE

Table of content: (NPI 1861642472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861642472 NPI number — SLEEP DIAGNOSTIC CENTER OF RANCHO MIRAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP DIAGNOSTIC CENTER OF RANCHO MIRAGE
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:
6
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:
1861642472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5319 UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612-2965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-699-7914
Provider Business Mailing Address Fax Number:
760-699-8052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35900 BOB HOPE DR
Provider Second Line Business Practice Location Address:
SUITE 172
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-1766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-699-7914
Provider Business Practice Location Address Fax Number:
760-699-8052
Provider Enumeration Date:
09/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AHDOOT
Authorized Official First Name:
JAHANGIR
Authorized Official Middle Name:
JONATHAN
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
760-699-7914

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com