Healthcare Provider Details

I. General information

NPI: 1043434038
Provider Name (Legal Business Name): AUDIOLOGY CONSULTANTS OF SO. CA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 SANTA MONICA BLVD SUITE 101
SANTA MONICA CA
90404-2533
US

IV. Provider business mailing address

PO BOX 571154
TARZANA CA
91357-1154
US

V. Phone/Fax

Practice location:
  • Phone: 818-943-7892
  • Fax: 818-244-8532
Mailing address:
  • Phone: 818-943-7892
  • Fax: 818-244-8532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2092
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA4022
License Number StateCA

VIII. Authorized Official

Name: HOWARD A HAMBURGER
Title or Position: OWNER
Credential:
Phone: 818-943-7892