Healthcare Provider Details

I. General information

NPI: 1356672380
Provider Name (Legal Business Name): SHURSON HEARING AND SPEECH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 W WHITENDALE AVE STE A
VISALIA CA
93277-6131
US

IV. Provider business mailing address

2316 W WHITENDALE AVE STE A
VISALIA CA
93277-6131
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-8960
  • Fax: 559-625-8962
Mailing address:
  • Phone: 559-625-8960
  • Fax: 559-625-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP23359
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1018
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU510
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA1145
License Number StateCA

VIII. Authorized Official

Name: DOLORES MARIA MALDONADO
Title or Position: MANAGER
Credential:
Phone: 559-625-8960