Basic Information
| Provider Information | |||||||||
| NPI: | 1215224613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SURREY | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | M | ||||||||
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| OtherLastName: | MAZUR | ||||||||
| OtherFirstName: | CAROL | ||||||||
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| OtherCredential: | M.S. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | FILE # 55745 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900745745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614788770 | ||||||||
| FaxNumber: | 5615987231 | ||||||||
| Practice Location | |||||||||
| Address1: | 386 E H ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919107485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196911108 | ||||||||
| FaxNumber: | 6196911109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2011 | ||||||||
| LastUpdateDate: | 07/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AU 1456 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.