Provider Demographics
NPI:1821655937
Name:MAGNOLIA SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:MAGNOLIA SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-779-8278
Mailing Address - Street 1:8370 WEST FLAGLER ST
Mailing Address - Street 2:# 244
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144
Mailing Address - Country:US
Mailing Address - Phone:305-779-8278
Mailing Address - Fax:305-740-1478
Practice Address - Street 1:8370 WEST FLAGLER ST
Practice Address - Street 2:# 244
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:305-779-8278
Practice Address - Fax:305-740-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic