Provider Demographics
NPI:1427363225
Name:PACIFIC SLEEP MEDICINE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PACIFIC SLEEP MEDICINE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-325-4100
Mailing Address - Street 1:555 E TACHEVAH DR STE 1E204
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5733
Mailing Address - Country:US
Mailing Address - Phone:760-325-4100
Mailing Address - Fax:760-778-6785
Practice Address - Street 1:555 E TACHEVAH DR STE 1E204
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5733
Practice Address - Country:US
Practice Address - Phone:760-325-4100
Practice Address - Fax:760-778-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic