Basic Information
| Provider Information | |||||||||
| NPI: | 1346423498 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPLETE SLEEP ANALYSIS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10532 ACACIA ST | ||||||||
| Address2: | SUITE B-4 | ||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917305446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094812577 | ||||||||
| FaxNumber: | 9498630491 | ||||||||
| Practice Location | |||||||||
| Address1: | 4226 AVENIDA COCHISE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856355818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204598618 | ||||||||
| FaxNumber: | 5204582865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2007 | ||||||||
| LastUpdateDate: | 10/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 9094812577 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AVASTRAUSA, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.