Provider Demographics
NPI:1003171638
Name:AUDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,
Authorized Official - Phone:707-523-4740
Mailing Address - Street 1:1111 SONOMA AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4819
Mailing Address - Country:US
Mailing Address - Phone:707-523-4740
Mailing Address - Fax:707-523-0231
Practice Address - Street 1:1615 HILL RD
Practice Address - Street 2:SUITE 9
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4340
Practice Address - Country:US
Practice Address - Phone:415-209-9909
Practice Address - Fax:415-209-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU758261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech