1962761445 NPI number — SLEEP DIAGNOSTIC CENTER OF IRVINE

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 1962761445 NPI number — SLEEP DIAGNOSTIC CENTER OF IRVINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP DIAGNOSTIC CENTER OF IRVINE
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:
1962761445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15775 LAGUNA CANYON RD
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-3189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-699-0303
Provider Business Mailing Address Fax Number:
951-296-0445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15775 LAGUNA CANYON RD
Provider Second Line Business Practice Location Address:
SUITE 290
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-699-0303
Provider Business Practice Location Address Fax Number:
951-296-0445
Provider Enumeration Date:
05/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
AHDOOT
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
951-699-0303

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  BUS10-00083 , 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)





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