Provider Demographics
NPI:1861642472
Name:SLEEP DIAGNOSTIC CENTER OF RANCHO MIRAGE
Entity type:Organization
Organization Name:SLEEP DIAGNOSTIC CENTER OF RANCHO MIRAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAHANGIR
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:AHDOOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-699-7914
Mailing Address - Street 1:5319 UNIVERSITY DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2965
Mailing Address - Country:US
Mailing Address - Phone:760-699-7914
Mailing Address - Fax:760-699-8052
Practice Address - Street 1:35900 BOB HOPE DR
Practice Address - Street 2:SUITE 172
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1766
Practice Address - Country:US
Practice Address - Phone:760-699-7914
Practice Address - Fax:760-699-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABO378AMedicare PIN