Provider Demographics
NPI:1255449369
Name:WEST COAST SLEEP DIAGNOSTICS
Entity type:Organization
Organization Name:WEST COAST SLEEP DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:951-693-4678
Mailing Address - Street 1:28991 OLD TOWN FRONT ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5803
Mailing Address - Country:US
Mailing Address - Phone:951-693-4678
Mailing Address - Fax:951-693-0870
Practice Address - Street 1:28991 OLD TOWN FRONT ST
Practice Address - Street 2:SUITE 107
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5803
Practice Address - Country:US
Practice Address - Phone:951-693-4678
Practice Address - Fax:951-693-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32071ZMedicare ID - Type Unspecified