Healthcare Provider Details

I. General information

NPI: 1396350930
Provider Name (Legal Business Name): COURTNEY SEKI AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST # 126
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

11201 BENTON ST # 126
LOMA LINDA CA
92357-1000
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 909-825-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number11893292-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: