Provider Demographics
NPI:1831637966
Name:PACIFIC SLEEP CARE
Entity Type:Organization
Organization Name:PACIFIC SLEEP CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:MACAIBAY
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:684-633-2838
Mailing Address - Street 1:4445 MATUU ROAD
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799
Mailing Address - Country:US
Mailing Address - Phone:684-633-2838
Mailing Address - Fax:684-633-5838
Practice Address - Street 1:4445 MATUU ROAD
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-4445
Practice Address - Country:US
Practice Address - Phone:684-633-2838
Practice Address - Fax:684-633-5838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS1408261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic