MEDICARE: VALLEY HEARING SCREENING SERVICES

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	293D00000X	Physiological Laboratory	0002408540-0001-3	CA

General Provider Information

NPI Number	:	1407095987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY HEARING SCREENING SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 4708
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91729-4708
Country	:	US
Telephone Number	:	818-307-5193
Fax Number	:	661-294-9227

Provider Business Practice Location Address
First Line	:	25115 AVENUE STANFORD
Second Line	:	SUITE A205
City	:	VALENCIA
State	:	CA
Zip	:	91355-1290
Country	:	US
Telephone Number	:	818-307-5193
Fax Number	:	661-294-9227

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILFREDO CRUZ
Credential	:
Telephone Number	:	818-307-5193

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	05/10/2009

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