=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972798882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUDY HENRY STANOWSKI HAD1347
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2007
-----------------------------------------------------
Last Update Date | 09/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19523 E CYPRESS ST SUITE D
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91724-2066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-915-0780
-----------------------------------------------------
Fax | 626-915-0780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19523 E CYPRESS ST SUITE D
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91724-2066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-915-0780
-----------------------------------------------------
Fax | 626-915-0780
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | HA1347
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------