Healthcare Provider Details

I. General information

NPI: 1376305086
Provider Name (Legal Business Name): WALNUT CREEK AUDIOLOGY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 OLYMPIC BLVD STE 202
WALNUT CREEK CA
94596-5094
US

IV. Provider business mailing address

1900 OLYMPIC BLVD STE 202
WALNUT CREEK CA
94596-5094
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-4455
  • Fax:
Mailing address:
  • Phone: 925-937-4455
  • Fax:

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: DR. SAMUEL TIMOTHY JOHNSON
Title or Position: AUDIOLOGIST/ OWNER/ PRESIDENT
Credential: AU.D
Phone: 707-494-4328