Healthcare Provider Details

I. General information

NPI: 1295520070
Provider Name (Legal Business Name): MODERN SLEEP PHYSICIANS OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

IV. Provider business mailing address

16150 NE 85TH ST STE 203
REDMOND WA
98052-3543
US

V. Phone/Fax

Practice location:
  • Phone: 669-231-8700
  • Fax: 425-636-2401
Mailing address:
  • Phone: 206-427-4242
  • Fax: 425-636-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GANDIS MAZEIKA
Title or Position: PRESIDENT
Credential: MD
Phone: 206-427-4242