Healthcare Provider Details

I. General information

NPI: 1649670084
Provider Name (Legal Business Name): PINNACLE SLEEP PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 W DEER VALLEY RD STE 110
PEORIA AZ
85382-2101
US

IV. Provider business mailing address

7707 W DEER VALLEY RD STE 110
PEORIA AZ
85382-2101
US

V. Phone/Fax

Practice location:
  • Phone: 623-218-1515
  • Fax:
Mailing address:
  • Phone: 623-218-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number35331
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KEVIN WRAY
Title or Position: MEMBER
Credential:
Phone: 623-399-8606