Healthcare Provider Details

I. General information

NPI: 1598948192
Provider Name (Legal Business Name): SAN JUAN HEARING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 E 30TH ST
FARMINGTON NM
87401-8900
US

IV. Provider business mailing address

2355 E 30TH ST
FARMINGTON NM
87401-8900
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-7474
  • Fax:
Mailing address:
  • Phone: 505-325-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number754
License Number StateNM

VIII. Authorized Official

Name: TIMOTHY ANDREW JONES
Title or Position: AUDIOLOGIST
Credential: M.A., CCC-A
Phone: 505-325-7474