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NPI Code Detail

MEDICARE: KIMBERLY ANN GUSTOVICH M.A., CCC-A

MEDICARE: KIMBERLY ANN GUSTOVICH M.A., CCC-A
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
1231H00000XAudiologistAU1249CA

General Provider Information

NPI Number : 1679524730
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ANN GUSTOVICH M.A., CCC-A
Provider Business Mailing Address
First Line : 4723 CASTLE RD
Second Line :
City : LA CANADA
State : CA
Zip : 91011-1444
Country : US
Telephone Number : 213-253-2677
Fax Number :
Provider Business Practice Location Address
First Line : 351 E TEMPLE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90012-3328
Country : US
Telephone Number : 213-253-2677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2006
Last Update Date : 07/08/2007

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Directions to “ KIMBERLY ANN GUSTOVICH M.A., CCC-A” Practice Location

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