Healthcare Provider Details

I. General information

NPI: 1184268310
Provider Name (Legal Business Name): OCOTILLO SLEEP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S DOBSON RD STE 3
MESA AZ
85202-6487
US

IV. Provider business mailing address

2150 S DOBSON RD STE 3
MESA AZ
85202-6487
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-1489
  • Fax:
Mailing address:
  • Phone: 480-256-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. STACEY LAYMAN
Title or Position: OWNER
Credential: DDS
Phone: 623-299-8799