Provider Demographics
NPI:1508095522
Name:PACIFIC SLEEP MEDICINE SERVICES, INC
Entity Type:Organization
Organization Name:PACIFIC SLEEP MEDICINE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-284-5515
Mailing Address - Street 1:10532 ACACIA ST
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5446
Mailing Address - Country:US
Mailing Address - Phone:909-481-2577
Mailing Address - Fax:909-481-2546
Practice Address - Street 1:555 WASHINGTON ST
Practice Address - Street 2:SUITE 1037
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2289
Practice Address - Country:US
Practice Address - Phone:619-293-0874
Practice Address - Fax:619-293-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-12
Last Update Date:2009-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies