Organization
PACIFIC SLEEP MEDICINE, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA M BOJORQUEZ (CREDENTIALING)
(909) 793-9190
Entity
Organization
Contact information
Practice address
104 E OLIVE AVE, STE 104, REDLANDS, CA 92373-5255
(909) 793-9190
(909) 793-9770
Mailing address
104 E OLIVE AVE, SUITE 104, REDLANDS, CA 92373-5255
(909) 793-9190
(909) 793-9770
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336228089
—
CA
01
—
290014553
MEDICARE RAILROAD
CA
Enumeration date
11/03/2006
Last updated
02/04/2011
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