=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629324132
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALIFORNIA HOME SLEEP TESTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2012
-----------------------------------------------------
Last Update Date | 08/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7770 N FRESNO ST STE 101
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-709-2580
-----------------------------------------------------
Fax | 559-432-7791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7770 N FRESNO ST STE 101
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-709-2580
-----------------------------------------------------
Fax | 559-432-7791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEPHEN O'HARA
-----------------------------------------------------
Credential | DDSMD
-----------------------------------------------------
Telephone | 559-709-2580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 4666
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------