Healthcare Provider Details

I. General information

NPI: 1407039480
Provider Name (Legal Business Name): LINDA KEIM WILTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 1028
BEVERLY HILLS CA
90211-3108
US

IV. Provider business mailing address

8500 WILSHIRE BLVD STE 1028
BEVERLY HILLS CA
90211-3108
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-3660
  • Fax: 310-659-6335
Mailing address:
  • Phone: 310-659-3660
  • Fax: 310-659-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU2569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: