Provider Demographics
NPI:1740433002
Name:PACIFIC SLEEP TECH INC
Entity Type:Organization
Organization Name:PACIFIC SLEEP TECH INC
Other - Org Name:SLEEP DISORDER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:REQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-531-7878
Mailing Address - Street 1:98-1247 KAAHUMANU ST STE 106
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5310
Mailing Address - Country:US
Mailing Address - Phone:808-531-7878
Mailing Address - Fax:808-531-7829
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 106
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5310
Practice Address - Country:US
Practice Address - Phone:808-531-7878
Practice Address - Fax:808-531-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIW27301992-01OtherGET LICENSE