Healthcare Provider Details

I. General information

NPI: 1164655668
Provider Name (Legal Business Name): EZ SLEEP LAB,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S CALVARY WAY SUITE B
COTTONWOOD AZ
86326-4165
US

IV. Provider business mailing address

PO BOX 47090
PHOENIX AZ
85068-7090
US

V. Phone/Fax

Practice location:
  • Phone: 602-550-4065
  • Fax: 623-934-5603
Mailing address:
  • Phone: 602-550-4065
  • Fax: 623-934-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SATTY BHOWRA
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-550-4065