Healthcare Provider Details

I. General information

NPI: 1407155377
Provider Name (Legal Business Name): NEW LIFE HEARING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAIN ST STE B
EL SEGUNDO CA
90245-3861
US

IV. Provider business mailing address

311 MAIN ST STE B
EL SEGUNDO CA
90245-3861
US

V. Phone/Fax

Practice location:
  • Phone: 310-210-8052
  • Fax: 310-335-0153
Mailing address:
  • Phone: 310-210-8052
  • Fax: 310-335-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA3783
License Number StateCA

VIII. Authorized Official

Name: ELLISSA VALENTINO
Title or Position: OWNER
Credential:
Phone: 310-210-8052