Healthcare Provider Details

I. General information

NPI: 1073721957
Provider Name (Legal Business Name): WEST COAST HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 WEST 11TH STREET
TRACY CA
95376-0000
US

IV. Provider business mailing address

131 ENTERPRISE RD
JOHNSTOWN NY
12095-3326
US

V. Phone/Fax

Practice location:
  • Phone: 209-839-9730
  • Fax: 209-836-6007
Mailing address:
  • Phone: 401-353-4174
  • Fax: 401-488-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number9287
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHT8249
License Number StateCA

VIII. Authorized Official

Name: KAYLA STEELE
Title or Position: INSURANCE COORDINATO
Credential:
Phone: 401-353-4174