MEDICARE: LINDA KEIM WILTZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	AU2569	CA

General Provider Information

NPI Number	:	1407039480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA KEIM WILTZ

Provider Business Mailing Address
First Line	:	8500 WILSHIRE BLVD STE 1028
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3108
Country	:	US
Telephone Number	:	310-659-3660
Fax Number	:	310-659-6335

Provider Business Practice Location Address
First Line	:	8500 WILSHIRE BLVD STE 1028
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3108
Country	:	US
Telephone Number	:	310-659-3660
Fax Number	:	310-659-6335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	06/05/2012

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