| Advanced Sleep And Gastroenterology Laboratories, Inc | |
|
4206 Technology Dr Suite 2 Modesto CA 95356-8769 | |
| (209) 492-0735 | |
| (209) 579-2354 |
| Full Name | Advanced Sleep And Gastroenterology Laboratories, Inc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 4206 Technology Dr, Modesto, California |
| Authorized Official Name and Position | Jonathan Sam Davidson (CEO) |
| Authorized Official Contact | 2097517165 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Sleep And Gastroenterology Laboratories, Inc Po Box 3068 Ceres CA 95307-9032 Ph: (209) 751-7165 | Advanced Sleep And Gastroenterology Laboratories, Inc 4206 Technology Dr Suite 2 Modesto CA 95356-8769 Ph: (209) 492-0735 |
| NPI Number | 1073947305 |
|---|---|
| Provider Enumeration Date | 08/22/2013 |
| Last Update Date | 08/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073947305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | G66389 (California) | Primary |
| 207RS0012X | Internal Medicine - Sleep Medicine | G66389 (California) | Secondary |
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