Provider Demographics
NPI:1699886911
Name:ALLIANCE SLEEP CENTER INC
Entity type:Organization
Organization Name:ALLIANCE SLEEP CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:FAGUNDES
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:5859-906-2551
Mailing Address - Street 1:2763 EAST SHAW AVENUE
Mailing Address - Street 2:#106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8220
Mailing Address - Country:US
Mailing Address - Phone:559-291-2400
Mailing Address - Fax:559-291-2422
Practice Address - Street 1:2763 EAST SHAW AVENUE #106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8220
Practice Address - Country:US
Practice Address - Phone:559-291-2400
Practice Address - Fax:559-291-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ31896ZMedicare ID - Type Unspecified