# MOTHERLODE SLEEP CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093965493
- **Authorized official:** MR. BRAD LEE BERRYMAN (PRESIDENT/CEO)
- **Authorized official phone:** (209) 588-8068

## Contact information

- **Practice address:** 729 PAULINE CT, SONORA, CA 95370
- **Practice address phone:** (209) 588-8068
- **Mailing address:** 729 PAULINE CT, SONORA, CA 95370
- **Mailing address phone:** (209) 588-8068

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | A79487 | CA | Yes |
| 261QS1200X | Sleep Disorder Diagnostic Clinic/Center | A79487 | CA | — |

## Other

- **Enumeration date:** 09/23/2008
- **Last updated:** 09/23/2008