Healthcare Provider Details

I. General information

NPI: 1245492172
Provider Name (Legal Business Name): HOME SLEEP LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 HAWK VIEW DR
ENCINITAS CA
92024-1274
US

IV. Provider business mailing address

1583 HAWK VIEW DR
ENCINITAS CA
92024-1274
US

V. Phone/Fax

Practice location:
  • Phone: 760-497-5089
  • Fax:
Mailing address:
  • Phone: 760-497-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ELAINE RUSSO GREGORY
Title or Position: OWNER
Credential:
Phone: 760-497-5089