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General NPI Number Information
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NPI Number | 1053602987
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Entity Type | Organization
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Legal Business Name | COCHISE COUNTY NEURODIAGNOSTICS
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 2160 E FRY BLVD STE C5
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2794
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Country | US
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Telephone | 520-335-7135
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 E FRY BLVD STE C5
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2794
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Country | US
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Telephone | 520-335-7135
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENDALEE A MCINTYRE
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Credential | B.S., RPSGT, REEGT
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Telephone | 520-335-7135
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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 | 8867
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License Number State | AZ
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