Healthcare Provider Details

I. General information

NPI: 1730927625
Provider Name (Legal Business Name): THE AUDITORY AND VESTIBULAR INSTITUTE OF LOS ANGELES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 LONG BEACH BLVD STE 110
LONG BEACH CA
90807-4023
US

IV. Provider business mailing address

3605 LONG BEACH BLVD STE 110
LONG BEACH CA
90807-4023
US

V. Phone/Fax

Practice location:
  • Phone: 323-524-3399
  • Fax: 562-989-8119
Mailing address:
  • Phone: 323-524-3399
  • Fax: 562-989-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. MIGUEL ANGELO AVILA
Title or Position: DOCTOR OF AUDIOLOGY
Credential: AU.D.
Phone: 323-524-3399