Healthcare Provider Details

I. General information

NPI: 1205260239
Provider Name (Legal Business Name): CANUHEARWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22849 N 19TH AVE STE 135
PHOENIX AZ
85027-1945
US

IV. Provider business mailing address

22849 N 19TH AVE STE 135
PHOENIX AZ
85027-1945
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-4327
  • Fax:
Mailing address:
  • Phone: 623-582-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD #5414
License Number StateAZ

VIII. Authorized Official

Name: LYNDA L ROBBINS
Title or Position: SPECIALIST
Credential: BC-HIS
Phone: 623-582-4327