Healthcare Provider Details

I. General information

NPI: 1871643254
Provider Name (Legal Business Name): JAMES A CVETKO AUDIOPROSTHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13631 N 59TH AVE
GLENDALE AZ
85304-1203
US

IV. Provider business mailing address

5809 W MELINDA LN
GLENDALE AZ
85308-6258
US

V. Phone/Fax

Practice location:
  • Phone: 602-841-9424
  • Fax: 602-841-3713
Mailing address:
  • Phone: 623-566-3183
  • Fax: 602-841-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1392
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: