Provider Demographics
NPI:1619306453
Name:SOUTH PACIFIC SLEEP LAB, INC.
Entity Type:Organization
Organization Name:SOUTH PACIFIC SLEEP LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMOON
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAVARCHI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:310-999-1887
Mailing Address - Street 1:19582 VENTURA BLVD STE 132
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2917
Mailing Address - Country:US
Mailing Address - Phone:818-701-8771
Mailing Address - Fax:818-812-9032
Practice Address - Street 1:5435 BALBOA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1566
Practice Address - Country:US
Practice Address - Phone:818-701-8771
Practice Address - Fax:818-812-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic