Provider Demographics
NPI:1134360217
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: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: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:909-418-2546
Practice Address - Street 1:500 17TH AVE
Practice Address - Street 2:SUITE A-20
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5711
Practice Address - Country:US
Practice Address - Phone:206-386-4744
Practice Address - Fax:206-215-1135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic