MEDICARE: DESERT MOON SLEEP LAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1235172065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT MOON SLEEP LAB LLC

Provider Business Mailing Address
First Line	:	2860 E FLAMINGO RD STE H
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5270
Country	:	US
Telephone Number	:	702-696-9002
Fax Number	:	702-696-9482

Provider Business Practice Location Address
First Line	:	2860 E FLAMINGO RD STE H
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5270
Country	:	US
Telephone Number	:	702-696-9002
Fax Number	:	702-696-9482

Authorized Official
Title or Position	:	OWNER/LAB MANAGER
Name	:	MR. PEDRO MORALES DURIAS II
Credential	:	RPSGT
Telephone Number	:	702-696-9002

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	09/02/2025

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