Organization
ADVANCED SLEEP DISORDER CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN SAM DAVIDSON M.D. (OWNER)
(209) 751-7165
Entity
Organization
Contact information
Practice address
4206 TECHNOLOGY DR STE 2, MODESTO, CA 95356-9484
(209) 751-7165
Mailing address
4206 TECHNOLOGY DR STE 2, MODESTO, CA 95356-9484
(209) 751-7165
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
G66389
CA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
G66389
CA
261Q00000X
Clinic/Center
Primary
G66389
CA
Other
Enumeration date
12/21/2007
Last updated
08/16/2013
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