Basic Information
| Provider Information | |||||||||
| NPI: | 1093091662 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMERICAN HEARING AID CENTER OF THE SOUTH BAY, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SONUS SF0024 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13820 DONNYBROOK LN | ||||||||
| Address2: | |||||||||
| City: | MOORPARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930212827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109893092 | ||||||||
| FaxNumber: | 8055303989 | ||||||||
| Practice Location | |||||||||
| Address1: | 9340 CLAIREMONT MESA BLVD | ||||||||
| Address2: | STE D | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582789911 | ||||||||
| FaxNumber: | 8585657324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2011 | ||||||||
| LastUpdateDate: | 10/28/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DANDURAND | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3109893092 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMERICAN HEARING AID CENTER OF THE SOUTH BAY, INC | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | BC-HIS | ||||||||
| NPICertificationDate: | 10/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | HA 2056 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.