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General NPI Number Information
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NPI Number | 1851533582
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Entity Type | Organization
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Legal Business Name | FABULOUS HEARING LLC
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Dates
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Enumeration Date | 03/26/2009
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 8881 FLETCHER PKWY 103
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City | LA MESA
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State | CA
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Zip | 91942-3134
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Country | US
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Telephone | 619-460-0180
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Fax | 619-460-0949
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Provider Business Mailing Address
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Address Line | PO BOX 224
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City | LOGANDALE
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State | NV
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Zip | 89021-0224
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Country | US
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Telephone | 702-807-7931
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Fax | 702-398-3757
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Authorized Official
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Title or Position | OWNER
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Name | SUZANNE KELLY
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Credential | MEMBER
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Telephone | 702-807-7931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | HA2450
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License Number State | CA
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