Healthcare Provider Details

I. General information

NPI: 1104967967
Provider Name (Legal Business Name): PROFESSIONAL HEARING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD STE 114
POWAY CA
92064-2058
US

IV. Provider business mailing address

15725 POMERADO RD STE 114
POWAY CA
92064-2058
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-3277
  • Fax: 858-451-6743
Mailing address:
  • Phone: 858-451-3277
  • Fax: 858-451-6743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU 778
License Number StateCA

VIII. Authorized Official

Name: RACHAEL BOLES
Title or Position: OFFICE MANAGER
Credential:
Phone: 760-489-6901