Healthcare Provider Details

I. General information

NPI: 1558536565
Provider Name (Legal Business Name): MISSION AUDIOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26302 LA PAZ RD 107
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

26302 LA PAZ RD 107
MISSION VIEJO CA
92691
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-7898
  • Fax: 949-855-1074
Mailing address:
  • Phone: 949-855-7898
  • Fax: 949-855-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN A SULLIVAN
Title or Position: AUDIO;OGIST
Credential: AU.D., FAAA
Phone: 949-855-7898