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General NPI Number Information
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NPI Number | 1649551235
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Entity Type | Organization
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Legal Business Name | TREASURE COAST SLEEP DISORDERS , LLC
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 06/07/2017
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Provider Practice Location Address
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Address Line | 188 NW CENTRAL PARK PLZ
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2451
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Country | US
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Telephone | 772-232-9990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | JENSEN BEACH
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State | FL
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Zip | 34958-0187
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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 | MARIA MAMANGAKIS
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Credential |
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Telephone | 772-232-9990
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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 |
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