Healthcare Provider Details

I. General information

NPI: 1831213867
Provider Name (Legal Business Name): EZ SLEEP LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 WILLOW CREEK RD SUITE A
PRESCOTT AZ
86301-1141
US

IV. Provider business mailing address

1590 WILLOW CREEK RD SUITE A
PRESCOTT AZ
86301-1141
US

V. Phone/Fax

Practice location:
  • Phone: 928-771-9314
  • Fax: 928-708-0505
Mailing address:
  • Phone: 928-771-9314
  • Fax: 928-708-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MARIA CARRILLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-200-8988