Provider Demographics
NPI:1548968134
Name:SIERRA NEUROMONITORING LLC
Entity type:Organization
Organization Name:SIERRA NEUROMONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:804-398-8505
Mailing Address - Street 1:830 WADSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2362
Mailing Address - Country:US
Mailing Address - Phone:804-398-8505
Mailing Address - Fax:
Practice Address - Street 1:830 WADSWORTH AVE
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2362
Practice Address - Country:US
Practice Address - Phone:804-398-8505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty