Provider Demographics
NPI:1477710689
Name:THE VICTORIAN HOUSE SLEEP CENTER LLC
Entity Type:Organization
Organization Name:THE VICTORIAN HOUSE SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:505-319-9617
Mailing Address - Street 1:5109 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3045
Mailing Address - Country:US
Mailing Address - Phone:505-888-6200
Mailing Address - Fax:505-888-6202
Practice Address - Street 1:4036 CORRALES RD
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9308
Practice Address - Country:US
Practice Address - Phone:505-319-9617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic