Healthcare Provider Details

I. General information

NPI: 1053065334
Provider Name (Legal Business Name): SOUNDSCAPE AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N 4TH ST STE 205B
MONTEBELLO CA
90640-4306
US

IV. Provider business mailing address

813 ALPINE ST APT 203
LOS ANGELES CA
90012-6406
US

V. Phone/Fax

Practice location:
  • Phone: 704-787-1109
  • Fax:
Mailing address:
  • Phone: 704-787-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. ANISH VIPIN THAKKAR
Title or Position: FOUNDER, OWNER
Credential: AU.D.
Phone: 704-787-1109