Healthcare Provider Details

I. General information

NPI: 1780012815
Provider Name (Legal Business Name): REM SLEEP DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23076 THREE NOTCH RD SUITE 302
CALIFORNIA MD
20619-2442
US

IV. Provider business mailing address

23076 THREE NOTCH RD SUITE 302
CALIFORNIA MD
20619-2442
US

V. Phone/Fax

Practice location:
  • Phone: 410-428-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID PAUL CABRAL
Title or Position: COORDINATOR
Credential: RPSGT, RST
Phone: 410-428-1800