MEDICARE: GREATER CORONA SLEEP DIAGNOSTIC CENTER

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1851589493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER CORONA SLEEP DIAGNOSTIC CENTER

Provider Business Mailing Address
First Line	:	341 MAGNOLIA AVE STE 201
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-3332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 MAGNOLIA AVE STE 203
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-3332
Country	:	US
Telephone Number	:	951-735-9211
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RHONDA SUTTON
Credential	:
Telephone Number	:	951-735-9211

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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