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General NPI Number Information
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NPI Number | 1053803148
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Entity Type | Organization
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Legal Business Name | SOMNIATUS MEDICAL GROUP INCORPORATED
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 41900 WINCHESTER RD # 102
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City | TEMECULA
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State | CA
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Zip | 92590-3403
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Country | US
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Telephone | 951-461-6502
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Fax | 951-296-3679
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Provider Business Mailing Address
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Address Line | PO BOX 7242
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City | SAN DIEGO
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State | CA
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Zip | 92167-0242
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL BUCKLEY
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Credential | DO
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Telephone | 310-792-3914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | CA
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