Basic Information
| Provider Information | |||||||||
| NPI: | 1265946586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA SLEEP NEUROLOGY ORGANIZATION FOR WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2651 ELM AVE STE 205 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908061638 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2651 ELM AVENUE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627285034 | ||||||||
| FaxNumber: | 5624909413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2017 | ||||||||
| LastUpdateDate: | 11/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | MATHUR | ||||||||
| AuthorizedOfficialFirstName: | MONIKA | ||||||||
| AuthorizedOfficialMiddleName: | GARG | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7346572818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No ID Information.