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General NPI Number Information
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NPI Number | 1487426144
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Entity Type | Organization
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Legal Business Name | CALIFORNIA STATE UNIVERSITY, LOS ANGELES
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | HEARING & BALANCE CENTER, LOWER LEVEL B1, SUITE B-10200 1000 S. FREMONT AVENUE
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City | ALHAMBRA
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State | CA
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Zip | 91803-8866
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Country | US
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Telephone | 626-382-0254
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Fax | 626-382-0256
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Provider Business Mailing Address
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Address Line | 1000 S FREMONT AVE UNIT 32
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City | ALHAMBRA
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State | CA
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Zip | 91803-8866
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Country | US
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Telephone | 626-382-0254
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Fax | 626-382-0256
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Authorized Official
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Title or Position | AUD PROGRAM DIRECTOR
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Name | PETER IVORY
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Credential | PHD
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Telephone | 818-521-3386
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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 |
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License Number State |
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