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General NPI Number Information
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NPI Number | 1013214915
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Entity Type | Organization
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Legal Business Name | SIERRA DIAGNOSTIC SLEEP LAB
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Dates
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Enumeration Date | 02/12/2011
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Last Update Date | 02/12/2011
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Provider Practice Location Address
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Address Line | 235 GAUCHO CT
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City | TEMPLETON
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State | CA
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Zip | 93465-5442
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Country | US
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Telephone | 805-835-1894
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Fax | 805-434-3171
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Provider Business Mailing Address
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Address Line | 235 GAUCHO CT
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City | TEMPLETON
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State | CA
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Zip | 93465-5442
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Country | US
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Telephone | 805-835-1894
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Fax | 805-434-3171
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Authorized Official
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Title or Position | OWNER GENERAL PARTNER
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Name | MRS. SHELLY ANN ROBERSON
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Credential | RESPIRATORY
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Telephone | 805-835-1894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 168800
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License Number State | CA
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