=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477308310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUDIO CLINIC HEARING AIDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2024
-----------------------------------------------------
Last Update Date | 04/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 424 N YARBROUGH DR STE C
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79915-3388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-226-9283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 424 N YARBROUGH DR STE C
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79915-3388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-226-9283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER OF ENTITY
-----------------------------------------------------
Name | ALEJANDRO GOMEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 915-226-9283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------