MEDICARE: SOUND BALANCE AUDIOLOGY, 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	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558428532	OTHER	CA	NPI

General Provider Information

NPI Number	:	1952507303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUND BALANCE AUDIOLOGY, INC

Provider Business Mailing Address
First Line	:	2420 VISTA WAY
Second Line	:	STE 205
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6190
Country	:	US
Telephone Number	:	760-721-7417
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 VISTA WAY
Second Line	:	STE 205
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6190
Country	:	US
Telephone Number	:	760-721-7417
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. VALERIE ANN MCGUIRE
Credential	:	M.A.
Telephone Number	:	760-721-7417

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/20/2007

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