MEDICARE: C2C DIAGNOSTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1407262272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C2C DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	5158 CLARETON DR
Second Line	:	UNIT 26
City	:	AGOURA
State	:	CA
Zip	:	91376-7001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5158 CLARETON DR
Second Line	:	UNIT 26
City	:	AGOURA
State	:	CA
Zip	:	91376-7001
Country	:	US
Telephone Number	:	818-456-4683
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. WILL SNYDER
Credential	:
Telephone Number	:	818-209-8753

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	01/18/2017

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