Provider Demographics
NPI:1053407882
Name:DIAGNOSTIC SLEEP CENTER
Entity type:Organization
Organization Name:DIAGNOSTIC SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-802-1441
Mailing Address - Street 1:2327 E HWY 35
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515
Mailing Address - Country:US
Mailing Address - Phone:979-849-7704
Mailing Address - Fax:979-849-7734
Practice Address - Street 1:2327 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3804
Practice Address - Country:US
Practice Address - Phone:979-849-7704
Practice Address - Fax:979-849-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156768701Medicaid
TXPL7079OtherBLUE CROSS BLUE SHEILD
FTS039Medicare PIN