| Organization Name: | SLEEP & BONE DENSITY CENTER OF SAN ANDREAS |
| NPI Number: | 1134529514 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DERRELL ANDRETTI WHISENTON (COO/SECRETARY) |
| Mailing Address: | 704 Mountain Ranch Rd Suite 205 San Andreas |
| State: | CA US |
| Postal Code: | 952499707 |
| Phone Number: | 2097545375 |
| Fax Number: | 2096004295 |
| NPI Enumeration Date: | 09/04/2014 |
| NPI Last Update Date: | 12/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 293D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Laboratories |
| Taxonomy Classification: | Physiological Laboratory |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A laboratory that operates independently of a hospital and physician |