MEDICARE: DREAM LAB 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	2279G1100X	General Care Registered Respiratory Therapist

General Provider Information

NPI Number	:	1750710596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM LAB INC

Provider Business Mailing Address
First Line	:	223 N LINCOLN AVE APT 14
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-1732
Country	:	US
Telephone Number	:	818-439-5525
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2693
Country	:	US
Telephone Number	:	818-439-5525
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JESSIE DAVID ESCOBAR
Credential	:
Telephone Number	:	818-439-5525

Provider Enumeration Date	:	11/02/2013
Last Update Date	:	11/02/2013

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