Provider Demographics
NPI:1194025858
Name:PACIFIC SLEEP MEDICINE, A MEDICAL CORP
Entity Type:Organization
Organization Name:PACIFIC SLEEP MEDICINE, A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-201-1725
Mailing Address - Street 1:104 E OLIVE AVE
Mailing Address - Street 2:104
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5255
Mailing Address - Country:US
Mailing Address - Phone:909-793-9190
Mailing Address - Fax:909-793-9770
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3937
Practice Address - Country:US
Practice Address - Phone:626-480-0033
Practice Address - Fax:626-480-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic