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General NPI Number Information
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NPI Number | 1902565807
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Entity Type | Organization
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Legal Business Name | STATEWIDE HEARING AID CENTERS, LLC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 2412 N PONDEROSA DR STE B101
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City | CAMARILLO
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State | CA
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Zip | 93010-2380
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Country | US
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Telephone | 805-482-1104
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Fax | 805-482-0112
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Provider Business Mailing Address
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Address Line | 2412 N PONDEROSA DR STE B101
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City | CAMARILLO
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State | CA
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Zip | 93010-2380
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Country | US
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Telephone | 805-482-1104
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Fax | 805-482-0112
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Authorized Official
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Title or Position | CEO
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Name | ROGER CALDWELL
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Credential |
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Telephone | 805-482-1104
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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