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General NPI Number Information
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NPI Number | 1184680019
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Entity Type | Organization
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Legal Business Name | ELLIOT BEACH CORP
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 4686 N 1ST ST
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City | FRESNO
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State | CA
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Zip | 93726-0903
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Country | US
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Telephone | 559-227-9509
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Fax | 559-227-2737
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Provider Business Mailing Address
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Address Line | 4686 N 1ST ST
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City | FRESNO
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State | CA
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Zip | 93726-0903
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Country | US
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Telephone | 559-227-9509
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Fax | 559-227-2737
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PREM KRISH
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Credential | PHD
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Telephone | 559-227-9509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 3899
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License Number State | CA
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