Healthcare Provider Details

I. General information

NPI: 1235378167
Provider Name (Legal Business Name): CALIFORNIA SLEEP DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 GAUCHO CT
TEMPLETON CA
93465-5442
US

IV. Provider business mailing address

235 GAUCHO CT
TEMPLETON CA
93465-5442
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-3171
  • Fax: 805-434-3171
Mailing address:
  • Phone: 805-434-3171
  • Fax: 805-434-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License NumberG51637
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number00016880
License Number StateCA

VIII. Authorized Official

Name: MRS. SHELLY ANN ROBERSON
Title or Position: OWNER
Credential: CRTT
Phone: 805-434-3171