Basic Information
| Provider Information | |||||||||
| NPI: | 1427277623 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEP MEDICINE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 KNOWLES DR STE 8 | ||||||||
| Address2: | |||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950321417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087308082 | ||||||||
| FaxNumber: | 4087300548 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 KNOWLES DR STE 8 | ||||||||
| Address2: | |||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950321417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087308082 | ||||||||
| FaxNumber: | 4087300548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANG | ||||||||
| AuthorizedOfficialFirstName: | GRACE | ||||||||
| AuthorizedOfficialMiddleName: | ZAPATA | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4087308082 | ||||||||
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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 | 261QS1200X | 041749 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.