Healthcare Provider Details

I. General information

NPI: 1750771028
Provider Name (Legal Business Name): MHC SOCAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD 103
BEVERLY HILLS CA
90211-3121
US

IV. Provider business mailing address

8941 S 700 E 204
SANDY UT
84070-2400
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-0332
  • Fax: 310-360-6891
Mailing address:
  • Phone: 801-849-8497
  • Fax: 801-200-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID LARSEN
Title or Position: CFO
Credential:
Phone: 801-849-8497