Healthcare Provider Details

I. General information

NPI: 1629455951
Provider Name (Legal Business Name): AUDIOLOGY ASSOCIATES OF LAS VEGAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 BULLARD AVE STE 101
CLOVIS CA
93612-1054
US

IV. Provider business mailing address

2501 COTTONTAIL LN
SOMERSET NJ
08873-5125
US

V. Phone/Fax

Practice location:
  • Phone: 559-224-1344
  • Fax:
Mailing address:
  • Phone: 559-224-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ED BRAUN
Title or Position: VP OF MANAGED CARE
Credential:
Phone: 732-564-7115