Healthcare Provider Details

I. General information

NPI: 1225477938
Provider Name (Legal Business Name): CLAIRE C COLLORD JOHNSON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE C COLLORD AUD

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 PARKWAY DR
LA MESA CA
91942-1596
US

IV. Provider business mailing address

2510 E SUNSET RD UNIT 5-260
LAS VEGAS NV
89120-3511
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-4327
  • Fax: 619-589-1864
Mailing address:
  • Phone: 702-798-0113
  • Fax: 866-291-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: