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General NPI Number Information
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NPI Number | 1194941039
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Entity Type | Organization
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Legal Business Name | MOJAVE DESERT HEARING AID CENTER
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 15028 7TH ST STE 8
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City | VICTORVILLE
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State | CA
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Zip | 92395-3857
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Country | US
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Telephone | 760-245-1653
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Fax |
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Provider Business Mailing Address
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Address Line | 15028 7TH ST STE 8
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City | VICTORVILLE
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State | CA
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Zip | 92395-3857
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Country | US
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Telephone | 760-245-1653
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Fax |
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Authorized Official
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Title or Position | OWNERDISPENSER
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Name | MRS. VICKI LYNN BROOKS
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Credential |
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Telephone | 760-245-1653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number |
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License Number State |
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