Provider Demographics
NPI:1932217791
Name:CONTRA COSTA SLEEP CENTER LLC
Entity Type:Organization
Organization Name:CONTRA COSTA SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-935-7667
Mailing Address - Street 1:1700 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-935-7667
Mailing Address - Fax:925-945-7667
Practice Address - Street 1:1700 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3191
Practice Address - Country:US
Practice Address - Phone:925-935-7667
Practice Address - Fax:925-945-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA034478261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA290015163OtherRR MEDICARE
CAZZZ05580ZOtherBLUE SHIELD PIN #
CAZZZ17498ZMedicare ID - Type Unspecified