Healthcare Provider Details

I. General information

NPI: 1750710596
Provider Name (Legal Business Name): DREAM LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 N CEDAR AVE
FRESNO CA
93720-2693
US

IV. Provider business mailing address

223 N LINCOLN AVE APT 14
MONTEREY PARK CA
91755-1732
US

V. Phone/Fax

Practice location:
  • Phone: 818-439-5525
  • Fax:
Mailing address:
  • Phone: 818-439-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JESSIE DAVID ESCOBAR
Title or Position: CEO
Credential:
Phone: 818-439-5525