Healthcare Provider Details

I. General information

NPI: 1508199449
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA AUDIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD SUITE 103
BEVERLY HILLS CA
90211-3121
US

IV. Provider business mailing address

8500 WILSHIRE BLVD SUITE 103
BEVERLY HILLS CA
90211-3121
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-0332
  • Fax: 310-360-6891
Mailing address:
  • Phone: 310-360-0332
  • Fax: 310-360-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA7382
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2631
License Number StateCA

VIII. Authorized Official

Name: JONATHAN C LEITERMAN
Title or Position: AUDIOLOGIST/PRESIDENT
Credential: SC.D
Phone: 310-360-0332