Healthcare Provider Details

I. General information

NPI: 1053678722
Provider Name (Legal Business Name): DAN W BOZARTH H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 JONES WAY STE 29
SIMI VALLEY CA
93065-1231
US

IV. Provider business mailing address

2650 JONES WAY STE 29
SIMI VALLEY CA
93065-1231
US

V. Phone/Fax

Practice location:
  • Phone: 805-581-4327
  • Fax: 805-583-4327
Mailing address:
  • Phone: 805-581-4327
  • Fax: 805-583-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 7496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: