=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730303009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUDIOLOGY SERVICES OF NEWHALL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23033 LYONS AVE STE 3
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-259-1687
-----------------------------------------------------
Fax | 661-259-9684
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23033 LYONS AVE STE 3
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-259-1687
-----------------------------------------------------
Fax | 661-259-9684
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RANDALL BARTLETT
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 661-259-1687
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AUD444
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------