Healthcare Provider Details

I. General information

NPI: 1215585831
Provider Name (Legal Business Name): MARANDA LAFAVE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N CHERRY ST
TULARE CA
93274-2251
US

IV. Provider business mailing address

2260 E CHESTNUT CT
VISALIA CA
93292-1797
US

V. Phone/Fax

Practice location:
  • Phone: 559-684-8703
  • Fax:
Mailing address:
  • Phone: 906-399-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001719
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: