Healthcare Provider Details

I. General information

NPI: 1194980862
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA SLEEP CLINIC A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 EUCLID AVE SUITE #206
NATIONAL CITY CA
91950-2957
US

IV. Provider business mailing address

P O BOX 88
NATIONAL CITY CA
91951-0088
US

V. Phone/Fax

Practice location:
  • Phone: 619-267-3188
  • Fax: 619-267-3388
Mailing address:
  • Phone: 619-267-3188
  • Fax: 619-267-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA48932
License Number StateCA

VIII. Authorized Official

Name: DOTTIE ANN D SAZON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-267-3188