Healthcare Provider Details

I. General information

NPI: 1063420800
Provider Name (Legal Business Name): SLEEPMED OF CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 W YOSEMITE AVE SUITE 2A
MANTECA CA
95337
US

IV. Provider business mailing address

99 ROSEWOOD DR STE 245
DANVERS MA
01923-4537
US

V. Phone/Fax

Practice location:
  • Phone: 209-239-3402
  • Fax: 209-239-3678
Mailing address:
  • Phone: 978-536-7400
  • Fax: 978-535-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEVEN RUSSELL
Title or Position: CFO
Credential:
Phone: 770-330-7836