Provider Demographics
NPI:1104369503
Name:PREFERRED SLEEP DIAGNOSTICS
Entity Type:Organization
Organization Name:PREFERRED SLEEP DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-525-6500
Mailing Address - Street 1:100 LAGUNA RD
Mailing Address - Street 2:STE 205
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3633
Mailing Address - Country:US
Mailing Address - Phone:714-525-6500
Mailing Address - Fax:714-489-8140
Practice Address - Street 1:100 LAGUNA RD
Practice Address - Street 2:STE 205
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3633
Practice Address - Country:US
Practice Address - Phone:714-525-6500
Practice Address - Fax:714-489-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic