Healthcare Provider Details

I. General information

NPI: 1497170963
Provider Name (Legal Business Name): DEEP SLEEP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E VIOLET AVE
MCALLEN TX
78504-2481
US

IV. Provider business mailing address

1501 FULLERTON AVE
MCALLEN TX
78504-5867
US

V. Phone/Fax

Practice location:
  • Phone: 956-682-4151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number726534
License Number StateTX

VIII. Authorized Official

Name: ROMULUS FROST III
Title or Position: DIRECT OWNER/PROVIDER
Credential:
Phone: 956-682-4151