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General NPI Number Information
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NPI Number | 1619532652
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Entity Type | Organization
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Legal Business Name | SLEEP EZE, LLC
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 4801 N BUTLER AVE STE 6102
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City | FARMINGTON
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State | NM
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Zip | 87401-2624
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Country | US
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Telephone | 505-325-9495
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Fax | 505-325-0705
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Provider Business Mailing Address
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Address Line | 4801 N BUTLER AVE STE 6102
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City | FARMINGTON
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State | NM
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Zip | 87401-2624
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Country | US
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Telephone | 505-325-9495
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Fax | 505-325-0705
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Authorized Official
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Title or Position | PRESIDENT
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Name | RACHEL DOUGLAS
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Credential |
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Telephone | 520-405-4088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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