Healthcare Provider Details

I. General information

NPI: 1225375744
Provider Name (Legal Business Name): AUDIOLOGY ASSOICATES OF LAS VEGAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 SUN CITY BLVD #104
LAS VEGAS NV
89134-1707
US

IV. Provider business mailing address

2501 COTTONTAIL LN
SOMERSET NJ
08873-5125
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-8069
  • Fax:
Mailing address:
  • Phone: 732-564-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA-1596
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number320
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVE DUTSON
Title or Position: GENERAL MANAGER
Credential:
Phone: 732-564-7115