Healthcare Provider Details

I. General information

NPI: 1932671864
Provider Name (Legal Business Name): SERGIO ENRIQUE ESCAMILLA HEARING AID DISPENSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BALDWIN AVE
ARCADIA CA
91007-7922
US

IV. Provider business mailing address

19808 SANDPIPER PL UNIT 4
NEWHALL CA
91321-4338
US

V. Phone/Fax

Practice location:
  • Phone: 626-321-4210
  • Fax:
Mailing address:
  • Phone: 661-964-9616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number8115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: