=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265914154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONFAB CONCIERGE AUDIOLOGY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2018
-----------------------------------------------------
Last Update Date | 09/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 SUNRIDGE ST
-----------------------------------------------------
City | PLAYA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90293-7610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-820-8887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 SUNRIDGE ST
-----------------------------------------------------
City | PLAYA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90293-7610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-820-8887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ASHLEY LOMBARDI
-----------------------------------------------------
Credential | AUD
-----------------------------------------------------
Telephone | 316-516-4779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | AU3065
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------