Basic Information
| Provider Information | |||||||||
| NPI: | 1760520183 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCV AUDIOLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23822 VALENCIA BLVD | ||||||||
| Address2: | STE #103 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913552058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612533277 | ||||||||
| FaxNumber: | 6612881490 | ||||||||
| Practice Location | |||||||||
| Address1: | 23822 VALENCIA BLVD | ||||||||
| Address2: | STE #103 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612533277 | ||||||||
| FaxNumber: | 6612881490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 11/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | ARONSON | ||||||||
| AuthorizedOfficialFirstName: | NOLA | ||||||||
| AuthorizedOfficialMiddleName: | CLARK | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6612881400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | AU749A | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | AU0007490 | 05 | CA | MEDICAID |