MEDICARE: PREMIER DESERT SLEEP CENTER, INC

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	3335772	CA

General Provider Information

NPI Number	:	1255624557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER DESERT SLEEP CENTER, INC

Provider Business Mailing Address
First Line	:	27349 JEFFERSON AVE STE 100
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92590-5611
Country	:	US
Telephone Number	:	760-832-9921
Fax Number	:

Provider Business Practice Location Address
First Line	:	27349 JEFFERSON AVE STE 100
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92590-5611
Country	:	US
Telephone Number	:	760-832-9921
Fax Number	:	760-832-9934

Authorized Official
Title or Position	:	MANAGER
Name	:	KRISTIN QUINTANILLA
Credential	:
Telephone Number	:	858-232-3143

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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