=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003001900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP DISORDER SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6141 SUNSET DR SUITE 101
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-405-8548
-----------------------------------------------------
Fax | 305-668-8740
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6141 SUNSET DR SUITE 101
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-405-8548
-----------------------------------------------------
Fax | 305-668-8740
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAFAEL ALFONSO GALLARDO
-----------------------------------------------------
Credential | CRT, RPSGT
-----------------------------------------------------
Telephone | 305-405-8548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------