Healthcare Provider Details

I. General information

NPI: 1447798921
Provider Name (Legal Business Name): ALISON BURNEY AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON GOREN AUD

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/22/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27472 PORTOLA PKWY # 205-190
FOOTHILL RANCH CA
92610-2853
US

IV. Provider business mailing address

27472 PORTOLA PKWY # 205-190
FOOTHILL RANCH CA
92610-2853
US

V. Phone/Fax

Practice location:
  • Phone: 240-620-6003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: