Basic Information
| Provider Information | |||||||||
| NPI: | 1841474822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH ORANGE COUNTY SLEEP CLINIC MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1449 | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928221449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149961633 | ||||||||
| FaxNumber: | 7149969267 | ||||||||
| Practice Location | |||||||||
| Address1: | 1915 SUNNYCREST DR | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928353626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144467240 | ||||||||
| FaxNumber: | 7144467245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2007 | ||||||||
| LastUpdateDate: | 12/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCNABB | ||||||||
| AuthorizedOfficialFirstName: | LOUIS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7144467454 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY5096 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 2084S0012X | C38832 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine | 2084S0012X | G36837 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1346329323 | 01 | CA | DR. MCNABB NPI | OTHER | 1730264912 | 01 | CA | DR. PETRIE NPI NUMBER | OTHER | 1083898043 | 01 | CA | DR. WHITE NPI NUMBER | OTHER |