Provider Demographics
NPI: | 1942447453 |
---|---|
Name: | INSTITUTE FOR SLEEP MEDICINE |
Entity Type: | Organization |
Organization Name: | INSTITUTE FOR SLEEP MEDICINE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JANA |
Authorized Official - Middle Name: | ROSENBERG |
Authorized Official - Last Name: | COOKE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 858-350-4357 |
Mailing Address - Street 1: | 12707 HIGH BLUFF DRIVE, SUITE 200 |
Mailing Address - Street 2: | C/O HEALTHCAP WEST |
Mailing Address - City: | SAN DIEGO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92130-2037 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 858-350-2037 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 801 ORANGE AVENUE |
Practice Address - Street 2: | SUITE 204 |
Practice Address - City: | CORONADO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92118-2663 |
Practice Address - Country: | US |
Practice Address - Phone: | 858-525-5808 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-01-21 |
Last Update Date: | 2009-01-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Single Specialty |