Healthcare Provider Details

I. General information

NPI: 1841474822
Provider Name (Legal Business Name): NORTH ORANGE COUNTY SLEEP CLINIC MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 SUNNYCREST DR
FULLERTON CA
92835-3626
US

IV. Provider business mailing address

PO BOX 1449
BREA CA
92822-1449
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-7240
  • Fax: 714-446-7245
Mailing address:
  • Phone: 714-996-1633
  • Fax: 714-996-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5096
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberC38832
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberG36837
License Number StateCA

VIII. Authorized Official

Name: DR. LOUIS J MCNABB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-446-7454