Healthcare Provider Details

I. General information

NPI: 1154649119
Provider Name (Legal Business Name): PENINSULA HEARING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 ROSECRANS ST SUITE A
SAN DIEGO CA
92106-2643
US

IV. Provider business mailing address

1310 ROSECRANS ST SUITE A
SAN DIEGO CA
92106-2643
US

V. Phone/Fax

Practice location:
  • Phone: 619-756-7848
  • Fax: 619-564-7056
Mailing address:
  • Phone: 619-756-7848
  • Fax: 619-564-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DENA RISO
Title or Position: MANAGER
Credential: AUD
Phone: 619-756-7848