Provider Demographics
NPI:1124527395
Name:PROGRESSIVE SLEEP MEDICINE, LLC.
Entity type:Organization
Organization Name:PROGRESSIVE SLEEP MEDICINE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-785-7190
Mailing Address - Street 1:4234 RIVERWALK PKWY STE 280
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3370
Mailing Address - Country:US
Mailing Address - Phone:951-785-7190
Mailing Address - Fax:951-688-7246
Practice Address - Street 1:4234 RIVERWALK PKWY STE 280
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3370
Practice Address - Country:US
Practice Address - Phone:951-785-7190
Practice Address - Fax:951-688-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies