MEDICARE: MR. KEVIN RAFAEL STANISH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	9723	CA

General Provider Information

NPI Number	:	1346710969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN RAFAEL STANISH

Provider Business Mailing Address
First Line	:	10490 E. BRIAR OAKS DRIVE UNIT B
Second Line	:
City	:	STANTON
State	:	CA
Zip	:	90680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 WESTMINSTER AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740
Country	:	US
Telephone Number	:	562-735-3909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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