Healthcare Provider Details

I. General information

NPI: 1548584949
Provider Name (Legal Business Name): TUSTIN AUDIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12791 NEWPORT AVENUE SUITE 101
TUSTIN CA
92780-2785
US

IV. Provider business mailing address

12791 NEWPORT AVENUE SUITE 101
TUSTIN CA
92780-2785
US

V. Phone/Fax

Practice location:
  • Phone: 714-731-6549
  • Fax: 714-730-5372
Mailing address:
  • Phone: 714-731-6549
  • Fax: 714-730-5372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: MS. LIN BERGER
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-731-6549