=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922207596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNCOAST LABORATORIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2007
-----------------------------------------------------
Last Update Date | 09/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7911 GARDEN GROVE BLVD.
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-889-1582
-----------------------------------------------------
Fax | 714-889-1568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 6539
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-889-1582
-----------------------------------------------------
Fax | 714-889-1568
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/HA
-----------------------------------------------------
Name | MARK HADDAD
-----------------------------------------------------
Credential | HA
-----------------------------------------------------
Telephone | 714-889-1582
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------