Healthcare Provider Details

I. General information

NPI: 1538484233
Provider Name (Legal Business Name): FIDELITY HEARING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13079 ARTESIA BLVD. B-104
CERRITOS CA
90703-1370
US

IV. Provider business mailing address

13079 ARTESIA BLVD. B-104
CERRITOS CA
90703-1370
US

V. Phone/Fax

Practice location:
  • Phone: 562-926-6066
  • Fax: 562-926-6069
Mailing address:
  • Phone: 562-926-6066
  • Fax: 562-926-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU2070
License Number StateCA

VIII. Authorized Official

Name: DAVID J DEKRIEK
Title or Position: OWNER
Credential: AU.D
Phone: 562-926-6066