Healthcare Provider Details

I. General information

NPI: 1518105972
Provider Name (Legal Business Name): ALL EARS HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3088 W RAMSEY ST
BANNING CA
92220-3724
US

IV. Provider business mailing address

9217 STEPHANIE ST
RIVERSIDE CA
92508-6271
US

V. Phone/Fax

Practice location:
  • Phone: 951-849-3838
  • Fax: 951-849-3880
Mailing address:
  • Phone: 951-776-9551
  • Fax: 951-849-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2322
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number7224
License Number StateCA

VIII. Authorized Official

Name: MR. TRAVIS J BERGMANS
Title or Position: OWNER
Credential: AUD
Phone: 951-849-3838