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General NPI Number Information
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NPI Number | 1548786023
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Entity Type | Organization
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Legal Business Name | SAN RAFAEL HEARING CENTER, LLC
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6518 E CARONDELET DR
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City | TUCSON
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State | AZ
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Zip | 85710-2117
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Country | US
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Telephone | 520-721-4554
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Fax | 888-422-1773
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Provider Business Mailing Address
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Address Line | 6518 E CARONDELET DR
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City | TUCSON
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State | AZ
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Zip | 85710-2117
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Country | US
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Telephone | 520-721-4554
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Fax | 888-422-1773
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Authorized Official
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Title or Position | OWNER
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Name | DAVID BRADLEY WEAVER
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Credential |
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Telephone | 520-721-4554
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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 | HAD1498
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License Number State | AZ
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