Provider Demographics
NPI:1114200342
Name:SLEEP & RESEARCH CENTER OF FOUNTAIN VALLEY
Entity type:Organization
Organization Name:SLEEP & RESEARCH CENTER OF FOUNTAIN VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GURR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:714-979-2999
Mailing Address - Street 1:11190 WARNER AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4019
Mailing Address - Country:US
Mailing Address - Phone:714-979-2999
Mailing Address - Fax:714-979-3999
Practice Address - Street 1:11190 WARNER AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4019
Practice Address - Country:US
Practice Address - Phone:714-979-2999
Practice Address - Fax:714-979-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory