Provider Demographics
NPI:1235614819
Name:VICTORY SLEEP CENTER
Entity type:Organization
Organization Name:VICTORY SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-383-0514
Mailing Address - Street 1:10770 I AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-5207
Mailing Address - Country:US
Mailing Address - Phone:760-383-0514
Mailing Address - Fax:760-867-2444
Practice Address - Street 1:10770 I AVE STE 101
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-5207
Practice Address - Country:US
Practice Address - Phone:760-383-0514
Practice Address - Fax:760-867-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory