Healthcare Provider Details

I. General information

NPI: 1982181350
Provider Name (Legal Business Name): WESTSIDE AUDIOLOGY AND HEARING AID CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD STE W301
GLENDALE AZ
85306-5606
US

IV. Provider business mailing address

5757 W THUNDERBIRD RD STE W301
GLENDALE AZ
85306-5606
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3777
  • Fax: 602-547-0379
Mailing address:
  • Phone: 602-938-3777
  • Fax: 602-547-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number21267225
License Number StateAZ

VIII. Authorized Official

Name: SUDHIR P AGARWAL
Title or Position: OWNER
Credential: MD
Phone: 602-938-3777