Provider Demographics
NPI:1932288685
Name:PACIFIC SLEEP MEDICINE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PACIFIC SLEEP MEDICINE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOJORQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-793-9190
Mailing Address - Street 1:104 E OLIVE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5255
Mailing Address - Country:US
Mailing Address - Phone:909-793-9190
Mailing Address - Fax:909-793-9770
Practice Address - Street 1:1250 S SUNSET AVE
Practice Address - Street 2:STE 303-B
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3961
Practice Address - Country:US
Practice Address - Phone:626-480-0033
Practice Address - Fax:626-480-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14362BMedicare PIN