Healthcare Provider Details

I. General information

NPI: 1295377893
Provider Name (Legal Business Name): SOUTH COUNTY SLEEP SOLUTIONS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4063 BIRCH ST STE 150
NEWPORT BEACH CA
92660-2240
US

IV. Provider business mailing address

4063 BIRCH ST STE 150
NEWPORT BEACH CA
92660-2240
US

V. Phone/Fax

Practice location:
  • Phone: 949-558-0554
  • Fax: 928-237-2213
Mailing address:
  • Phone: 949-558-0554
  • Fax: 928-237-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANA JOE ROCKEY
Title or Position: OWNER
Credential: DMD
Phone: 949-558-0554