Healthcare Provider Details

I. General information

NPI: 1851533582
Provider Name (Legal Business Name): FABULOUS HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 FLETCHER PKWY 103
LA MESA CA
91942-3134
US

IV. Provider business mailing address

PO BOX 224
LOGANDALE NV
89021-0224
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-0180
  • Fax: 619-460-0949
Mailing address:
  • Phone: 702-807-7931
  • Fax: 702-398-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHA2450
License Number StateCA

VIII. Authorized Official

Name: SUZANNE KELLY
Title or Position: OWNER
Credential: MEMBER
Phone: 702-807-7931