Healthcare Provider Details

I. General information

NPI: 1710186747
Provider Name (Legal Business Name): MIRACLE EAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E VIA RANCHO PKWY
ESCONDIDO CA
92025-8005
US

IV. Provider business mailing address

5000 CHESHIRE LN N
PLYMOUTH MN
55446-3706
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-4205
  • Fax: 760-480-2322
Mailing address:
  • Phone: 888-333-9152
  • Fax: 763-268-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL M D'AMICO
Title or Position: VICE PRESIDENT
Credential:
Phone: 888-333-9152