Healthcare Provider Details

I. General information

NPI: 1366607913
Provider Name (Legal Business Name): COAST HEARING SERVICES, A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 E COAST HWY
CORONA DEL MAR CA
92625-2404
US

IV. Provider business mailing address

3545 E COAST HWY
CORONA DEL MAR CA
92625-2404
US

V. Phone/Fax

Practice location:
  • Phone: 949-675-3833
  • Fax: 949-723-4822
Mailing address:
  • Phone: 949-675-3833
  • Fax: 949-723-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1223
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA2780
License Number StateCA

VIII. Authorized Official

Name: DONNA FELKER CODY
Title or Position: AUDIOLOGIST
Credential: AU.D
Phone: 949-675-3833