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General NPI Number Information
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NPI Number | 1336279157
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Entity Type | Individual
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Provider Name | KENT E WEAVER AUD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 26726 CROWN VALLEY PKWY #210
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8006
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Country | US
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Telephone | 959-364-4361
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Fax | 949-364-7124
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Provider Business Mailing Address
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Address Line | 26726 CROWN VALLEY PKWY #210
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8006
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Country | US
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Telephone | 959-364-4361
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Fax | 949-364-7124
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 00461
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 00744
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AU3093
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU3093
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License Number State | CA
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