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General NPI Number Information
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NPI Number | 1003290040
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Entity Type | Organization
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Legal Business Name | MONTEREY BAY SLEEP CENTER, LLC
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Dates
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Enumeration Date | 07/18/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 60 GARDEN COURT SUITE 250
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City | MONTEREY
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State | CA
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Zip | 93940
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Country | US
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Telephone | 831-920-1411
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Fax | 831-920-1452
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Provider Business Mailing Address
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Address Line | 60 GARDEN COURT SUITE 250
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City | MONTEREY
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State | CA
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Zip | 93940
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Country | US
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Telephone | 831-920-1411
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Fax | 831-920-1452
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JOHN KOOSTRA
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Credential | MD
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Telephone | 831-920-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 261QS12000X
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License Number State | CA
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