MEDICARE: LOS ANGELES AUDIOLOGY GROUP, INC.

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	237600000X	Audiologist-Hearing Aid Fitter	AU1730	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1710993993	OTHER	CA	INDIVIDUAL NPI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801044698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES AUDIOLOGY GROUP, INC.

Provider Business Mailing Address
First Line	:	3875 WILSHIRE BLVD
Second Line	:	SUITE 302
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3205
Country	:	US
Telephone Number	:	213-386-6108
Fax Number	:	213-386-6182

Provider Business Practice Location Address
First Line	:	3875 WILSHIRE BLVD
Second Line	:	SUITE 302
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3205
Country	:	US
Telephone Number	:	213-386-6108
Fax Number	:	213-386-6182

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW DENZIL MICHAELS
Credential	:	M.S.
Telephone Number	:	213-386-6108

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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Directions to “LOS ANGELES AUDIOLOGY GROUP, INC. ” Practice Location

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