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General NPI Number Information
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NPI Number | 1407095136
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Entity Type | Individual
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Provider Name | JAMES RUSSELL ANDERSON M.A., CCC/A
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Gender | Male
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/22/2009
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Provider Practice Location Address
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Address Line | 25150 HANCOCK AVE SUITE 204
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City | MURRIETA
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State | CA
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Zip | 92562-5987
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Country | US
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Telephone | 951-698-4148
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Fax | 951-698-7411
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Provider Business Mailing Address
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Address Line | 25150 HANCOCK AVE SUITE 204
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City | MURRIETA
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State | CA
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Zip | 92562-5987
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Country | US
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Telephone |
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Fax |
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AU1072
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License Number State | CA
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