Organization
MOTHERLODE SLEEP CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD LEE BERRYMAN (PRESIDENT/CEO)
(209) 588-8068
Entity
Organization
Contact information
Practice address
729 PAULINE CT, SONORA, CA 95370
(209) 588-8068
Mailing address
729 PAULINE CT, SONORA, CA 95370
(209) 588-8068
Taxonomy
Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
A79487
CA
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
A79487
CA
Other
Enumeration date
09/23/2008
Last updated
09/23/2008
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