Healthcare Provider Details

I. General information

NPI: 1457407496
Provider Name (Legal Business Name): AUDIO ETC, , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 GOVERNOR DR MIRACLE-EAR CENTER
SAN DIEGO CA
92122-2522
US

IV. Provider business mailing address

2741 GLASGOW DR
CARLSBAD CA
92010-6537
US

V. Phone/Fax

Practice location:
  • Phone: 858-458-9019
  • Fax: 858-458-9268
Mailing address:
  • Phone: 760-729-6129
  • Fax: 760-729-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA3693
License Number StateCA

VIII. Authorized Official

Name: MR. CLIFFORD WILLIAM JOHNSON JR.
Title or Position: PRESIDENT
Credential:
Phone: 760-729-6129