MEDICARE: DENTON GARO POLYSOMNOGRAPHY TECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1306877337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENTON GARO POLYSOMNOGRAPHY TECH

Provider Business Mailing Address
First Line	:	2414 S FAIRVIEW ST
Second Line	:	SUITE #110
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5318
Country	:	US
Telephone Number	:	714-668-0629
Fax Number	:	714-668-0642

Provider Business Practice Location Address
First Line	:	2414 S FAIRVIEW ST
Second Line	:	SUITE #110
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5318
Country	:	US
Telephone Number	:	714-668-0629
Fax Number	:	714-668-0642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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Directions to “ DENTON GARO POLYSOMNOGRAPHY TECH” Practice Location

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