Provider Demographics
NPI:1760650857
Name:FOUNTAIN VALLEY REGIONAL SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:FOUNTAIN VALLEY REGIONAL SLEEP CENTER, LLC
Other - Org Name:HSD SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ARAMBULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-427-5900
Mailing Address - Street 1:17150 EUCLID ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4092
Mailing Address - Country:US
Mailing Address - Phone:714-427-5900
Mailing Address - Fax:714-427-5907
Practice Address - Street 1:17150 EUCLID ST STE 300
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:714-427-5900
Practice Address - Fax:714-427-5907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA007413OtherBUSINESS TAX CERTIFICATE