Provider Demographics
NPI:1235620832
Name:CALAVERAS SLEEP DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:CALAVERAS SLEEP DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-217-2973
Mailing Address - Street 1:700 MOUNTAIN RANCH RD # A2
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9785
Mailing Address - Country:US
Mailing Address - Phone:209-497-4830
Mailing Address - Fax:209-497-4888
Practice Address - Street 1:700 MOUNTAIN RANCH RD # A2
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9785
Practice Address - Country:US
Practice Address - Phone:209-497-4830
Practice Address - Fax:209-497-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic