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General NPI Number Information
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NPI Number | 1255624557
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Entity Type | Organization
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Legal Business Name | PREMIER DESERT SLEEP CENTER, INC
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 27349 JEFFERSON AVE STE 100
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City | TEMECULA
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State | CA
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Zip | 92590-5611
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Country | US
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Telephone | 760-832-9921
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Fax | 760-832-9934
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Provider Business Mailing Address
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Address Line | 27349 JEFFERSON AVE STE 100
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City | TEMECULA
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State | CA
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Zip | 92590-5611
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Country | US
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Telephone | 760-832-9921
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KRISTIN QUINTANILLA
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Credential |
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Telephone | 858-232-3143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 3335772
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License Number State | CA
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