Healthcare Provider Details

I. General information

NPI: 1730571332
Provider Name (Legal Business Name): AT2J ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SIMI TOWN CENTER WAY STE 3
SIMI VALLEY CA
93065-8408
US

IV. Provider business mailing address

1717 SIMI TOWN CENTER WAY STE 3
SIMI VALLEY CA
93065-8408
US

V. Phone/Fax

Practice location:
  • Phone: 805-579-9324
  • Fax:
Mailing address:
  • Phone: 805-579-9324
  • Fax:

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: DR. JOHN MALAN
Title or Position: PRESIDENT
Credential:
Phone: 805-579-9324