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General NPI Number Information
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NPI Number | 1609190628
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Entity Type | Organization
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Legal Business Name | INCUS HEARING LLC
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Dates
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Enumeration Date | 03/19/2010
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 702 E GRIFFIN PKWY SUITE 4
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City | MISSION
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State | TX
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Zip | 78572-2918
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Country | US
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Telephone | 956-534-3837
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Fax |
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Provider Business Mailing Address
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Address Line | 702 E GRIFFIN PKWY SUITE 4
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City | MISSION
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State | TX
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Zip | 78572-2918
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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 | MANAGING MEMBER
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Name | ISAAC FARIAS
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Credential | M.S.
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Telephone | 956-534-3837
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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 | 51306
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License Number State | TX
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