=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952575458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURBANK HEARING CLINIC A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2008
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 N SAN FERNANDO BLVD
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91502-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-842-4069
-----------------------------------------------------
Fax | 818-848-1616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 127 N SAN FERNANDO BLVD
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91502-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-842-4069
-----------------------------------------------------
Fax | 818-848-1616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / DIRECTOR / AUDIOLOGIST
-----------------------------------------------------
Name | MR. COURTLANDT C. WARNER
-----------------------------------------------------
Credential | M.A., CCC-A
-----------------------------------------------------
Telephone | 818-842-4069
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | HA2679
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AU2077
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------