Healthcare Provider Details

I. General information

NPI: 1427263334
Provider Name (Legal Business Name): HARBOR AUDIOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADRID BLVD SUITE 214
PUNTA GORDA FL
33950
US

IV. Provider business mailing address

100 MADRID BLVD SUITE 214
PUNTA GORDA FL
33950
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-0400
  • Fax: 941-505-0022
Mailing address:
  • Phone: 941-505-0400
  • Fax: 941-505-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. RICARDO GAUTHIER
Title or Position: OWNER/AUDIOLOGIST
Credential: AU.D.
Phone: 941-505-0400