Provider Demographics
NPI:1851421317
Name:INTEGRATED SLEEP CENTER, INC.
Entity Type:Organization
Organization Name:INTEGRATED SLEEP CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-824-9919
Mailing Address - Street 1:PO BOX 12549
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-0549
Mailing Address - Country:US
Mailing Address - Phone:210-824-9919
Mailing Address - Fax:210-824-9917
Practice Address - Street 1:910 SAN PEDRO AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4642
Practice Address - Country:US
Practice Address - Phone:210-824-9919
Practice Address - Fax:210-824-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7317641OtherAETNA
TXPL7119OtherBLUE CROSS BLUE SHIELD
TXFTSP31Medicare PIN