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General NPI Number Information
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NPI Number | 1598126161
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Entity Type | Organization
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Legal Business Name | PINE RIVER INC
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 1620 PENNSYLVANIA AVE STE D
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City | FAIRFIELD
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State | CA
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Zip | 94533-3509
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Country | US
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Telephone | 707-426-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 PENNSYLVANIA AVE STE D
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City | FAIRFIELD
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State | CA
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Zip | 94533-3509
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Country | US
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Telephone | 707-426-4327
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENISE MARTIN-SAHIM
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Credential |
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Telephone | 707-642-8862
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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