Healthcare Provider Details

I. General information

NPI: 1215003553
Provider Name (Legal Business Name): AUDIOSCOPE AUDIOLOGY GROUP APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 CAMINO DEL RIO S SUITE 220
SAN DIEGO CA
92108-3815
US

IV. Provider business mailing address

2815 CAMINO DEL RIO S SUITE 220
SAN DIEGO CA
92108-3815
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-6772
  • Fax: 858-279-7505
Mailing address:
  • Phone: 858-279-6772
  • Fax: 858-279-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GAYLE ELLEN HICKS
Title or Position: PRESIDENT
Credential: PHD
Phone: 858-279-6772