Healthcare Provider Details

I. General information

NPI: 1659787018
Provider Name (Legal Business Name): WEST COAST AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 ALVARADO RD STE 714
LA MESA CA
91942-8216
US

IV. Provider business mailing address

7777 ALVARADO RD STE 714
LA MESA CA
91942-8216
US

V. Phone/Fax

Practice location:
  • Phone: 619-713-0017
  • Fax:
Mailing address:
  • Phone: 619-713-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU2506
License Number StateCA

VIII. Authorized Official

Name: ALEC GRAHAM
Title or Position: OWNER
Credential:
Phone: 619-713-0017