Healthcare Provider Details

I. General information

NPI: 1184174716
Provider Name (Legal Business Name): AUDIOLOGY PROFESSIONAL SERVICES OF LA CANADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 FOOTHILL BLVD SUITE C
LA CANADA CA
91011-2107
US

IV. Provider business mailing address

1434 FOOTHILL BLVD UNIT C
LA CANADA CA
91011-2166
US

V. Phone/Fax

Practice location:
  • Phone: 818-928-1400
  • Fax: 626-963-7207
Mailing address:
  • Phone: 818-928-1400
  • Fax: 626-963-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2924
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2924
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2924
License Number StateCA

VIII. Authorized Official

Name: DR. KEVIN H IVORY
Title or Position: PRESIDENT/OWNER
Credential: AUD
Phone: 818-928-1400