Basic Information
| Provider Information | |||||||||
| NPI: | 1245813146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POZO CASTILLO | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | HAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 GARDEN GROVE BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926838234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148985732 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 CENTERPOINTE DR STE 9A | ||||||||
| Address2: | |||||||||
| City: | LA PALMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906232577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145629950 | ||||||||
| FaxNumber: | 7145629956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2021 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA8648 | CA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | HA8648 | 01 | CA | SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY AND HEARING AID DISPENSERS BOARD | OTHER |