Healthcare Provider Details

I. General information

NPI: 1639317936
Provider Name (Legal Business Name): BEN STANOWSKI HA4010
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 MT VIEW AVE STE A
LOMA LINDA CA
92354-3858
US

IV. Provider business mailing address

11340 MT VIEW AVE STE A
LOMA LINDA CA
92354-3858
US

V. Phone/Fax

Practice location:
  • Phone: 909-796-2354
  • Fax: 909-796-2357
Mailing address:
  • Phone: 909-796-2354
  • Fax: 909-796-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA4010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: