Healthcare Provider Details

I. General information

NPI: 1619990488
Provider Name (Legal Business Name): HEARING SERVICES OF ANTIOCH A PROFESSIONAL AUDIOLOGY CORPRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 LONE TREE WAY SUITE D
ANTIOCH CA
94531-6200
US

IV. Provider business mailing address

4045 LONE TREE WAY SUITE D
ANTIOCH CA
94531-6200
US

V. Phone/Fax

Practice location:
  • Phone: 925-778-3298
  • Fax: 925-778-0937
Mailing address:
  • Phone: 925-778-3298
  • Fax: 925-778-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA3465
License Number StateCA

VIII. Authorized Official

Name: MARY JANE GARNETT
Title or Position: OWNER
Credential: AU.D
Phone: 925-778-3298