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NPI Code Detail

MEDICARE: DR. DAVID M ILLICH AUD, C.C.C.A.

MEDICARE: DR. DAVID M ILLICH AUD, C.C.C.A.
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
1231H00000XAudiologistAU 778CA

General Provider Information

NPI Number : 1528125754
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID M ILLICH AUD, C.C.C.A.
Provider Business Mailing Address
First Line : 1745 TIERRA LIBERTIA RD
Second Line :
City : ESCONDIDO
State : CA
Zip : 92026-7824
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1045 E VALLEY PKWY
Second Line :
City : ESCONDIDO
State : CA
Zip : 92025-4618
Country : US
Telephone Number : 760-489-6901
Fax Number : 760-489-1694
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 07/08/2007

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