Provider Demographics
NPI:1417030818
Name:JOSEPH L. LESCANO
Entity Type:Organization
Organization Name:JOSEPH L. LESCANO
Other - Org Name:PACIFIC SLEEP CARE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANLUTAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-647-5477
Mailing Address - Street 1:PO BOX 5622
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96929
Mailing Address - Country:US
Mailing Address - Phone:671-647-5477
Mailing Address - Fax:671-646-6876
Practice Address - Street 1:2221 ARMY DR STE 209 MANHATTAN PLAZA
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-647-5477
Practice Address - Fax:671-646-6876
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH L LESCANO DBA MEDQUEST MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1200X, 335E00000X, 335G00000X
GU332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUM0098148Medicaid
GUM0098148Medicaid
4960160001Medicare NSC