Healthcare Provider Details

I. General information

NPI: 1184235459
Provider Name (Legal Business Name): AUDIOLOGY AND INTEGRATED PROFESSIONAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17768 WIKA RD STE 200
APPLE VALLEY CA
92307-1200
US

IV. Provider business mailing address

17768 WIKA RD STE 200
APPLE VALLEY CA
92307-1200
US

V. Phone/Fax

Practice location:
  • Phone: 760-503-1700
  • Fax: 760-503-1728
Mailing address:
  • Phone: 760-503-1700
  • Fax: 760-503-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA MARIE MENDOZA
Title or Position: AUDIOLOGIST
Credential:
Phone: 760-503-1700