Provider Demographics
NPI:1023321130
Name:PENINSULA SLEEP LAB
Entity type:Organization
Organization Name:PENINSULA SLEEP LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VERZOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-279-9336
Mailing Address - Street 1:91 WESTBOROUGH BLVD
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3162
Mailing Address - Country:US
Mailing Address - Phone:650-741-4180
Mailing Address - Fax:
Practice Address - Street 1:91 WESTBOROUGH BLVD
Practice Address - Street 2:SUITE 1020
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3162
Practice Address - Country:US
Practice Address - Phone:650-741-4180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-17
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE4842057291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory