Basic Information
| Provider Information | |||||||||
| NPI: | 1780936625 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUPERIOR HEARING SOLUTIONS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | MIRACLE EAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20610 ARCHWOOD ST | ||||||||
| Address2: | |||||||||
| City: | WINNETKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913064009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239925336 | ||||||||
| FaxNumber: | 8185081483 | ||||||||
| Practice Location | |||||||||
| Address1: | 12121 VICTORY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916063204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187540382 | ||||||||
| FaxNumber: | 8185081483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 10/02/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VILLASENOR | ||||||||
| AuthorizedOfficialFirstName: | ESTELA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | HEARING AID DISPENSER | ||||||||
| AuthorizedOfficialTelephone: | 8187540382 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | HAD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | HA4051 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
No ID Information.