Healthcare Provider Details

I. General information

NPI: 1447625751
Provider Name (Legal Business Name): CEDARNORTH SLEEP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 N CEDAR AVE STE 102
FRESNO CA
93720-3838
US

IV. Provider business mailing address

7405 N CEDAR AVE STE 102
FRESNO CA
93720-3838
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-4948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29003
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA63350
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BETTINA TONG
Title or Position: PARTNER
Credential:
Phone: 559-432-4948