Basic Information
| Provider Information | |||||||||
| NPI: | 1154762011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIREGNA | ||||||||
| FirstName: | MAHALET | ||||||||
| MiddleName: | CANDACE | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 N COMMONS DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605047940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303035380 | ||||||||
| FaxNumber: | 6303035385 | ||||||||
| Practice Location | |||||||||
| Address1: | 3144 EL CAMINO REAL STE 105 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920082194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607297800 | ||||||||
| FaxNumber: | 7607297878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | DA9464 | AZ | N | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | 10156 | CA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | AU3551 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.