Healthcare Provider Details

I. General information

NPI: 1497046684
Provider Name (Legal Business Name): AZ SLEEP CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 W WETHERSFIELD DR
GLENDALE AZ
85304-1844
US

IV. Provider business mailing address

5825 W WETHERSFIELD DR
GLENDALE AZ
85304-1844
US

V. Phone/Fax

Practice location:
  • Phone: 623-776-6450
  • Fax:
Mailing address:
  • Phone: 623-776-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TROY D SEBASTIAN
Title or Position: OWNER
Credential:
Phone: 623-776-6450