Healthcare Provider Details

I. General information

NPI: 1952575458
Provider Name (Legal Business Name): BURBANK HEARING CLINIC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N SAN FERNANDO BLVD
BURBANK CA
91502-1208
US

IV. Provider business mailing address

127 N SAN FERNANDO BLVD
BURBANK CA
91502-1208
US

V. Phone/Fax

Practice location:
  • Phone: 818-842-4069
  • Fax: 818-848-1616
Mailing address:
  • Phone: 818-842-4069
  • Fax: 818-848-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2077
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA2679
License Number StateCA

VIII. Authorized Official

Name: MR. COURTLANDT C. WARNER
Title or Position: PRESIDENT / DIRECTOR / AUDIOLOGIST
Credential: M.A., CCC-A
Phone: 818-842-4069