Provider Demographics
NPI:1235172065
Name:DESERT MOON SLEEP LAB LLC
Entity Type:Organization
Organization Name:DESERT MOON SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LAB MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:DURIAS
Authorized Official - Suffix:II
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:702-696-9002
Mailing Address - Street 1:2840 E FLAMINGO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5201
Mailing Address - Country:US
Mailing Address - Phone:702-696-9002
Mailing Address - Fax:702-696-9482
Practice Address - Street 1:2840 E FLAMINGO RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5201
Practice Address - Country:US
Practice Address - Phone:702-696-9002
Practice Address - Fax:702-696-9482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2663348291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory