Healthcare Provider Details

I. General information

NPI: 1578754594
Provider Name (Legal Business Name): REDWOOD COAST HEARING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 E WASHINGTON BLVD SUITE 14
CRESCENT CITY CA
95531-8343
US

IV. Provider business mailing address

785 E WASHINGTON BLVD SUITE 14
CRESCENT CITY CA
95531-8343
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-7121
  • Fax: 707-464-7151
Mailing address:
  • Phone: 707-464-7121
  • Fax: 707-464-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHTL8265
License Number StateCA

VIII. Authorized Official

Name: DAVID WAYNE GAGER
Title or Position: AUDIOLOGIST/OWNER
Credential: M.S.
Phone: 707-464-7121