Provider Demographics
NPI:1013214915
Name:SIERRA DIAGNOSTIC SLEEP LAB
Entity Type:Organization
Organization Name:SIERRA DIAGNOSTIC SLEEP LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RESPIRATORY
Authorized Official - Phone:805-835-1894
Mailing Address - Street 1:235 GAUCHO CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-5442
Mailing Address - Country:US
Mailing Address - Phone:805-835-1894
Mailing Address - Fax:805-434-3171
Practice Address - Street 1:235 GAUCHO CT
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-5442
Practice Address - Country:US
Practice Address - Phone:805-835-1894
Practice Address - Fax:805-434-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168800291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory