=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750618591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUDIOLOGY AND HEARING AID CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2009
-----------------------------------------------------
Last Update Date | 11/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4910 VAN NUYS BLVD STE 201
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-1879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-783-1035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4910 VAN NUYS BLVD STE 201
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-1879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-783-1035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST
-----------------------------------------------------
Name | ANDRES GODINEZ
-----------------------------------------------------
Credential | M.S.
-----------------------------------------------------
Telephone | 818-783-1035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | AU2267
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------