Organization Name: | LUCID SLEEP INC |
NPI Number: | 1043238082 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MIKAEL ENEVOLDSEN (CEO) |
Mailing Address: | 8333 Foothill Blvd Suite 103 Rancho Cucamonga |
State: | CA US |
Postal Code: | 91730 |
Phone Number: | 8779958243 |
Fax Number: | 8779958253 |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QS1200X |
License Number: | 2558471 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Sleep Disorder Diagnostic |
Taxonomy Definition: |