Basic Information
| Provider Information | |||||||||
| NPI: | 1255359378 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PULMONARY MEDICINE ASSOCIATES SLEEP LAB INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 ETHAN WAY STE 600 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958252296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166793524 | ||||||||
| FaxNumber: | 9164887432 | ||||||||
| Practice Location | |||||||||
| Address1: | 1508 ALHAMBRA BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958166510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163251040 | ||||||||
| FaxNumber: | 9164511141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 10/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | EFSTRATIS | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS SERVICES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9166793524 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PULMONARY MEDICINE ASSOCIATES MEDICAL GROUP, INC | ||||||||
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| NPICertificationDate: | 10/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.