Healthcare Provider Details

I. General information

NPI: 1609209956
Provider Name (Legal Business Name): ELITE SLEEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14065 TIERRA BONITA CT
POWAY CA
92064-3068
US

IV. Provider business mailing address

14065 TIERRA BONITA CT
POWAY CA
92064-3068
US

V. Phone/Fax

Practice location:
  • Phone: 858-391-3096
  • Fax: 866-393-9868
Mailing address:
  • Phone: 858-391-3096
  • Fax: 866-393-9868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. THOMAS ANTHONY D'ACQUISTO
Title or Position: DIRECTOR
Credential:
Phone: 760-844-2331