Basic Information
| Provider Information | |||||||||
| NPI: | 1548584949 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TUSTIN AUDIOLOGY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12791 NEWPORT AVENUE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927802785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147316549 | ||||||||
| FaxNumber: | 7147305372 | ||||||||
| Practice Location | |||||||||
| Address1: | 12791 NEWPORT AVENUE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927802785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147316549 | ||||||||
| FaxNumber: | 7147305372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2010 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | BERGER | ||||||||
| AuthorizedOfficialFirstName: | LIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7147316549 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.