Provider Demographics
NPI:1235378167
Name:CALIFORNIA SLEEP DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:CALIFORNIA SLEEP DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:CRTT
Authorized Official - Phone:805-434-3171
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:805-434-3171
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:805-434-3171
Practice Address - Fax:805-434-3171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONNIE R SMITH M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-17
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51637173F00000X
CA00016880291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93095Medicare UPIN