Healthcare Provider Details

I. General information

NPI: 1801861588
Provider Name (Legal Business Name): INGRID KRISTINA MCBRIDE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7353 E SAYAN ST
MESA AZ
85207-1821
US

IV. Provider business mailing address

7353 E SAYAN ST
MESA AZ
85207-1821
US

V. Phone/Fax

Practice location:
  • Phone: 602-578-9541
  • Fax: 480-218-4362
Mailing address:
  • Phone: 480-965-0614
  • Fax: 480-965-0076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA829
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberDA829
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA829
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: