MEDICARE: SLEEP DISORDER CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center	HCC7320	FL

General Provider Information

NPI Number	:	1053498675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP DISORDER CENTER INC

Provider Business Mailing Address
First Line	:	145 MADEIRA AVE
Second Line	:	SUITE 209
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4520
Country	:	US
Telephone Number	:	305-443-9223
Fax Number	:	305-443-9225

Provider Business Practice Location Address
First Line	:	145 MADEIRA AVE
Second Line	:	SUITE 209
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4520
Country	:	US
Telephone Number	:	305-443-9223
Fax Number	:	305-443-9225

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. ELENA P. REYES
Credential	:
Telephone Number	:	305-443-9223

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	10/18/2012

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