Healthcare Provider Details

I. General information

NPI: 1376763102
Provider Name (Legal Business Name): AUDIOLOGY CENTER OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 LAUREL CANYON BLVD SUITE D
LOS ANGELES CA
90046-2138
US

IV. Provider business mailing address

PO BOX 480184
LOS ANGELES CA
90048-1184
US

V. Phone/Fax

Practice location:
  • Phone: 323-851-6556
  • Fax: 232-851-6593
Mailing address:
  • Phone: 323-851-6556
  • Fax: 323-851-6593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU64
License Number StateCA

VIII. Authorized Official

Name: LYNDA DALE GLUCK
Title or Position: OWNER
Credential: MA
Phone: 323-851-6556