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General NPI Number Information
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NPI Number | 1821810391
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Entity Type | Organization
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Legal Business Name | BLUESLEEP CA INC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 9855 ERMA RD STE 103
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City | SAN DIEGO
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State | CA
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Zip | 92131-1007
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Country | US
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Telephone | 212-683-0174
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Fax |
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Provider Business Mailing Address
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Address Line | 15 BROAD ST APT 2414
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City | NEW YORK
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State | NY
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Zip | 10005-1989
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Country | US
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Telephone | 212-683-0174
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORDAN CHARLES STERN
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Credential | MD
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Telephone | 212-683-0174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number |
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License Number State |
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