MEDICARE: NEW MEXICO SLEEP LABS

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

General Provider Information

NPI Number	:	1104575521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO SLEEP LABS

Provider Business Mailing Address
First Line	:	PO BOX 663
Second Line	:
City	:	SUNLAND PARK
State	:	NM
Zip	:	88063-0663
Country	:	US
Telephone Number	:	915-779-7378
Fax Number	:	915-779-2822

Provider Business Practice Location Address
First Line	:	1155 COMMERCE DR STE G
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8257
Country	:	US
Telephone Number	:	575-647-5337
Fax Number	:	575-647-5338

Authorized Official
Title or Position	:	OWNER
Name	:	GONZALO A DIAZ
Credential	:	MD
Telephone Number	:	915-779-7378

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	03/22/2022

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