Provider Demographics
NPI:1831263912
Name:COMPLETE SLEEP ANALYSIS LLC
Entity type:Organization
Organization Name:COMPLETE SLEEP ANALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-481-2577
Mailing Address - Street 1:10532 ACACIA ST
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5446
Mailing Address - Country:US
Mailing Address - Phone:909-481-2577
Mailing Address - Fax:602-682-7632
Practice Address - Street 1:4226 AVENIDA COCHISE
Practice Address - Street 2:SUITE 10
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5818
Practice Address - Country:US
Practice Address - Phone:520-459-8618
Practice Address - Fax:520-458-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZGROUP Z113594Medicare PIN
AZ113594Medicare PIN