Provider Demographics
NPI:1679743686
Name:THERAPEUTIC SLEEP LAB OF RIVERSIDE
Entity Type:Organization
Organization Name:THERAPEUTIC SLEEP LAB OF RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/RESPIRATORY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:877-836-8227
Mailing Address - Street 1:11401 HEACOCK ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7908
Mailing Address - Country:US
Mailing Address - Phone:877-836-8227
Mailing Address - Fax:951-243-9444
Practice Address - Street 1:11401 HEACOCK ST
Practice Address - Street 2:SUITE 340
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7908
Practice Address - Country:US
Practice Address - Phone:877-836-8227
Practice Address - Fax:951-243-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory