=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104967967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL HEARING ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 02/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15725 POMERADO RD STE 114
-----------------------------------------------------
City | POWAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92064-2058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-451-3277
-----------------------------------------------------
Fax | 858-451-6743
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15725 POMERADO RD STE 114
-----------------------------------------------------
City | POWAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92064-2058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-451-3277
-----------------------------------------------------
Fax | 858-451-6743
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | RACHAEL BOLES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-489-6901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | AU 778
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------