Healthcare Provider Details

I. General information

NPI: 1508045295
Provider Name (Legal Business Name): PACIFIC SLEEP LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 CAMINO DE LOS MARES SUITE 201
SAN CLEMENTE CA
92673-2835
US

IV. Provider business mailing address

675 CAMINO DE LOS MARES SUITE 201
SAN CLEMENTE CA
92673-2835
US

V. Phone/Fax

Practice location:
  • Phone: 949-366-2701
  • Fax: 949-429-6918
Mailing address:
  • Phone: 949-366-2701
  • Fax: 949-429-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberTG252
License Number StateCA

VIII. Authorized Official

Name: INCHEL YEAM
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: PHYSICIAN
Phone: 949-366-2701