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General NPI Number Information
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NPI Number | 1306012067
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Entity Type | Organization
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Legal Business Name | GULF COAST AUDIOLOGY OF SOUTHWEST FLORIDA LLC
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 8900 GLADIOLUS DR SUITE 201
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City | FORT MYERS
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State | FL
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Zip | 33908-4487
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Country | US
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Telephone | 239-267-7888
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Fax | 239-267-0409
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Provider Business Mailing Address
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Address Line | 8900 GLADIOLUS DR SUITE 201
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City | FORT MYERS
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State | FL
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Zip | 33908-4487
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Country | US
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Telephone | 239-267-7888
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Fax | 239-267-0409
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Authorized Official
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Title or Position | AUDIOLOGIST/OWNER
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Name | DR. DRIANIS DURAN
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Credential | AU.D.
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Telephone | 239-267-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | AY1164
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License Number State | FL
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