Basic Information
| Provider Information | |||||||||
| NPI: | 1508199449 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN CALIFORNIA AUDIOLOGY ASSOCIATES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOCAL HEARING AND BALANCE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8500 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902113121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103600332 | ||||||||
| FaxNumber: | 3103606891 | ||||||||
| Practice Location | |||||||||
| Address1: | 8500 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902113121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103600332 | ||||||||
| FaxNumber: | 3103606891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2009 | ||||||||
| LastUpdateDate: | 09/10/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LEITERMAN | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | AUDIOLOGIST/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3103600332 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTHERN CALIFORNIA AUDIOLOGY ASSOCIATES | ||||||||
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| AuthorizedOfficialCredential: | SC.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | HA7382 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | AU2631 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.