Healthcare Provider Details

I. General information

NPI: 1114467255
Provider Name (Legal Business Name): ANN GROSCH HA 8179
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST SUITE 320-A
BURBANK CA
91505-4554
US

IV. Provider business mailing address

191 S BUENA VISTA ST SUITE 320-A
BURBANK CA
91505-4554
US

V. Phone/Fax

Practice location:
  • Phone: 818-559-9580
  • Fax: 818-559-1341
Mailing address:
  • Phone: 818-559-9580
  • Fax: 818-559-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA 8179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: