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General NPI Number Information
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NPI Number | 1639499171
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE SLEEP MEDICINE
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 9681 BUSINESS CENTER DR BUILDING 16, SUITE B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4579
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Country | US
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Telephone | 323-651-5522
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Fax | 323-651-5523
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Provider Business Mailing Address
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Address Line | 303 LOMA DR
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City | LOS ANGELES
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State | CA
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Zip | 90017-1103
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Country | US
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Telephone | 323-651-5522
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Fax | 323-651-5523
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Authorized Official
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Title or Position | ASSISTANT CLINICAL MANAGER
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Name | JOSHUA TAL
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Credential |
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Telephone | 323-651-5522
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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 |
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License Number State | CA
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