Healthcare Provider Details

I. General information

NPI: 1114006277
Provider Name (Legal Business Name): SAN LEANDRO SLEEP DISORDERS CENTER, PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13939 E 14TH ST
SAN LEANDRO CA
94578-2613
US

IV. Provider business mailing address

13847 E 14TH ST STE 200
SAN LEANDRO CA
94578-2626
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-5470
  • Fax:
Mailing address:
  • Phone: 510-352-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WU
Title or Position: M.D.
Credential: M.D.
Phone: 510-352-5470