Healthcare Provider Details

I. General information

NPI: 1427149483
Provider Name (Legal Business Name): EXCEPTIONAL HEARING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 REDWOOD HIGHWAY SUITE A-12
SAN RAFAEL CA
94903
US

IV. Provider business mailing address

4340 REDWOOD HIGHWAY SUITE A-12
SAN RAFAEL CA
94903
US

V. Phone/Fax

Practice location:
  • Phone: 415-499-7766
  • Fax:
Mailing address:
  • Phone: 415-499-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHA3627
License Number StateCA

VIII. Authorized Official

Name: MS. SOL J BARROS
Title or Position: AUDIOLOGIST/DIRECTOR
Credential: MS,CCC-A
Phone: 415-499-7766