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General NPI Number Information
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NPI Number | 1346607454
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Entity Type | Organization
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Legal Business Name | SPECIALIZED SLEEP DIAGNOSTICS
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 983 RESERVE DR
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City | ROSEVILLE
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State | CA
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Zip | 95678-1340
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Country | US
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Telephone | 916-337-5502
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Fax | 916-258-7277
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Provider Business Mailing Address
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Address Line | PO BOX 6342
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City | FOLSOM
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State | CA
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Zip | 95763-6342
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Country | US
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Telephone | 916-337-5502
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Fax | 916-258-7277
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Authorized Official
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Title or Position | RPSGT OWNER
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Name | CHARLES TOLBERT
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Credential | RPSGT
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Telephone | 916-337-9635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | PTGL296
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License Number State | CA
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