Healthcare Provider Details

I. General information

NPI: 1750426201
Provider Name (Legal Business Name): SANDRA T OGAWA HEARING AID DISPENSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 CRENSHAW BLVD. SUITE 101
TORRANCE CA
90504
US

IV. Provider business mailing address

17777 CRENSHAW BLVD. SUITE 101
TORRANCE CA
90504
US

V. Phone/Fax

Practice location:
  • Phone: 310-327-7031
  • Fax: 310-327-7635
Mailing address:
  • Phone: 310-327-7031
  • Fax: 310-327-7635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA3890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: