Healthcare Provider Details

I. General information

NPI: 1073219986
Provider Name (Legal Business Name): CREATIVE HEARING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 EMPIRE ST STE 210
FAIRFIELD CA
94533-5562
US

IV. Provider business mailing address

744 EMPIRE ST STE 210
FAIRFIELD CA
94533-5562
US

V. Phone/Fax

Practice location:
  • Phone: 707-759-4419
  • Fax: 510-483-3685
Mailing address:
  • Phone: 707-759-4419
  • Fax: 510-483-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEMITRIOS PALILIS
Title or Position: OWNER
Credential: AUD
Phone: 707-759-4419