Healthcare Provider Details

I. General information

NPI: 1972918480
Provider Name (Legal Business Name): PERFORMANCE SLEEP LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 CAMINO DEL MAR STE F
DEL MAR CA
92014-2553
US

IV. Provider business mailing address

1349 CAMINO DEL MAR SUITE F
DEL MAR CA
92014-2553
US

V. Phone/Fax

Practice location:
  • Phone: 858-353-5455
  • Fax:
Mailing address:
  • Phone: 858-755-1166
  • Fax: 888-399-9098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number3633810
License Number StateCA

VIII. Authorized Official

Name: CAMERON ABBASOV
Title or Position: CEO/FOUNDER
Credential:
Phone: 858-353-5455