Provider Demographics
NPI:1194980862
Name:SOUTHERN CALIFORNIA SLEEP CLINIC A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA SLEEP CLINIC A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOTTIE ANN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-267-3188
Mailing Address - Street 1:P O BOX 88
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91951-0088
Mailing Address - Country:US
Mailing Address - Phone:619-267-3188
Mailing Address - Fax:619-267-3388
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE #206
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-267-3188
Practice Address - Fax:619-267-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RP1001X
CAA48932207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48932Medicare PIN