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General NPI Number Information
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NPI Number | 1811403835
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Entity Type | Organization
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Legal Business Name | PACIFIC HEARING CONNECTION
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 496 1ST ST STE 120
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City | LOS ALTOS
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State | CA
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Zip | 94022-3677
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Country | US
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Telephone | 650-941-0664
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Fax |
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Provider Business Mailing Address
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Address Line | 496 1ST ST STE 120
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City | LOS ALTOS
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State | CA
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Zip | 94022-3677
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Country | US
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Telephone | 650-941-0664
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEBORAH WILSON CLARK
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Credential | AU.D.
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Telephone | 650-941-0664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU1833
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License Number State | CA
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