Provider Demographics
NPI:1841364015
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:
Practice Address - Street 1:5200 E CORTLAND BLVD
Practice Address - Street 2:SUITE D-6
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-9337
Practice Address - Country:US
Practice Address - Phone:928-522-9053
Practice Address - Fax:928-522-9076
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 Licenses
StateLicense IDTaxonomies
AZOTC004261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic