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General NPI Number Information
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NPI Number | 1295123669
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Entity Type | Organization
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Legal Business Name | EAST VALLEY AUDIOLOGY
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 191 SO. BUENA VISTA SUITE 320-A
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City | BURBANK
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State | CA
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Zip | 91505
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Country | US
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Telephone | 818-559-9580
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Fax |
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Provider Business Mailing Address
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Address Line | 191 SO. BUENA VISTA SUITE 320-A
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City | BURBANK
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State | CA
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Zip | 91505
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Country | US
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Telephone | 818-559-9580
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Fax | 818-559-1341
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Authorized Official
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Title or Position | PRESIDENT
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Name | WARREN S. LINE JR.
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Credential |
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Telephone | 818-559-9727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State | CA
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