Provider Demographics
NPI:1346607454
Name:SPECIALIZED SLEEP DIAGNOSTICS
Entity Type:Organization
Organization Name:SPECIALIZED SLEEP DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPSGT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:916-337-9635
Mailing Address - Street 1:PO BOX 6342
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-6342
Mailing Address - Country:US
Mailing Address - Phone:916-337-5502
Mailing Address - Fax:916-258-7277
Practice Address - Street 1:983 RESERVE DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1340
Practice Address - Country:US
Practice Address - Phone:916-337-5502
Practice Address - Fax:916-258-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTGL296246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty