Provider Demographics
NPI:1285938530
Name:ST JUDE SLEEP SOLUTIONS
Entity type:Organization
Organization Name:ST JUDE SLEEP SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY THERAPIST/TECH
Authorized Official - Prefix:
Authorized Official - First Name:DYESEBEL
Authorized Official - Middle Name:GICA
Authorized Official - Last Name:ALVARO
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED RESPIRATOR
Authorized Official - Phone:702-885-3371
Mailing Address - Street 1:6268 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3240
Mailing Address - Country:US
Mailing Address - Phone:702-818-4008
Mailing Address - Fax:702-818-5446
Practice Address - Street 1:6268 S RAINBOW BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3240
Practice Address - Country:US
Practice Address - Phone:702-818-4008
Practice Address - Fax:702-818-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC651291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory