Provider Demographics
NPI:1801834312
Name:EASTLAKE SLEEP CENTER
Entity Type:Organization
Organization Name:EASTLAKE SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-623-3822
Mailing Address - Street 1:841 KUHN DR
Mailing Address - Street 2:STE#201
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3552
Mailing Address - Country:US
Mailing Address - Phone:619-623-3822
Mailing Address - Fax:619-623-3824
Practice Address - Street 1:841 KUHN DR
Practice Address - Street 2:STE#201
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3552
Practice Address - Country:US
Practice Address - Phone:619-623-3822
Practice Address - Fax:619-623-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic