Basic Information
Provider Information | |||||||||
NPI: | 1518038181 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RIFKIND | ||||||||
FirstName: | PATRICE | ||||||||
MiddleName: | ANGELIQUE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 25425 ORCHARD VILLAGE ROAD | ||||||||
Address2: | SUITE 220 | ||||||||
City: | SANTA CLARITA | ||||||||
State: | CA | ||||||||
PostalCode: | 913552935 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6612881400 | ||||||||
FaxNumber: | 6612881490 | ||||||||
Practice Location | |||||||||
Address1: | 25425 ORCHARD VILLAGE ROAD | ||||||||
Address2: | SUITE 220 | ||||||||
City: | SANTA CLARITA | ||||||||
State: | CA | ||||||||
PostalCode: | 913552935 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6612841900 | ||||||||
FaxNumber: | 6612881490 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/13/2006 | ||||||||
LastUpdateDate: | 04/29/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/14/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 237600000X | CA | Y |   | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |   |
ID Information
ID | Type | State | Issuer | Description | AU1663 | 01 | CA | STATE AUDIOLOGY LICENSE | OTHER |