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General NPI Number Information
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NPI Number | 1679743686
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC SLEEP LAB OF RIVERSIDE
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 11401 HEACOCK ST SUITE 340
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City | MORENO VALLEY
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State | CA
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Zip | 92557-7908
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Country | US
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Telephone | 877-836-8227
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Fax | 951-243-9444
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Provider Business Mailing Address
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Address Line | 11401 HEACOCK ST SUITE 340
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City | MORENO VALLEY
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State | CA
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Zip | 92557-7908
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Country | US
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Telephone | 877-836-8227
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Fax | 951-243-9444
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Authorized Official
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Title or Position | CEO/RESPIRATORY THERAPIST
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Name | MR. SAMUEL ANGEL MONTES
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Credential | RCP
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Telephone | 877-836-8227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | CA
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