Provider Demographics
NPI:1194033159
Name:MAISON DIAGNOSTICS
Entity type:Organization
Organization Name:MAISON DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BAPI
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOHANTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-396-8446
Mailing Address - Street 1:1515 S SUNKIST ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5808
Mailing Address - Country:US
Mailing Address - Phone:714-396-8446
Mailing Address - Fax:
Practice Address - Street 1:1515 S SUNKIST ST
Practice Address - Street 2:SUITE G
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5808
Practice Address - Country:US
Practice Address - Phone:714-396-8446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty