=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013274026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP CONSULTANTS OF CALIFORNIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2012
-----------------------------------------------------
Last Update Date | 06/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2740 N GAREY AVE STE 203
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-293-3700
-----------------------------------------------------
Fax | 855-293-3701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2740 N GAREY AVE STE 203
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-293-3700
-----------------------------------------------------
Fax | 855-293-3701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ZACHARY ROBBINS
-----------------------------------------------------
Credential | RPSGT
-----------------------------------------------------
Telephone | 855-293-3700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------