Healthcare Provider Details

I. General information

NPI: 1679641351
Provider Name (Legal Business Name): SLEEP LOGISTIC DIAGNOSTIC CLINIS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6787 W TROPICANA AVE STE 100
LAS VEGAS NV
89103-4762
US

IV. Provider business mailing address

6787 W TROPICANA AVE STE 100
LAS VEGAS NV
89103-4762
US

V. Phone/Fax

Practice location:
  • Phone: 702-893-0020
  • Fax: 702-893-0025
Mailing address:
  • Phone: 702-893-0020
  • Fax: 702-893-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. RHONDA G MITCHELL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 702-893-0020