Healthcare Provider Details

I. General information

NPI: 1538464706
Provider Name (Legal Business Name): YUCAIPA HEARING AID CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12197 CALIFORNIA ST
YUCAIPA CA
92399-4332
US

IV. Provider business mailing address

12197 CALIFORNIA ST
YUCAIPA CA
92399-4332
US

V. Phone/Fax

Practice location:
  • Phone: 909-797-2104
  • Fax: 909-797-6724
Mailing address:
  • Phone: 909-797-2104
  • Fax: 909-797-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA5067
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHA5067
License Number StateCA

VIII. Authorized Official

Name: MS. STEPHANIE K WOOD
Title or Position: VP OPERATIONS
Credential:
Phone: 909-797-2104