Healthcare Provider Details

I. General information

NPI: 1164838843
Provider Name (Legal Business Name): KATHY LEE TOVA HA7430
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 COLORADO AVE SUITE # 150
TURLOCK CA
95382-2706
US

IV. Provider business mailing address

1801 COLORADO AVE SUITE # 150
TURLOCK CA
95382-2706
US

V. Phone/Fax

Practice location:
  • Phone: 209-216-3300
  • Fax: 209-216-3316
Mailing address:
  • Phone: 209-216-3300
  • Fax: 209-216-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: