Provider Demographics
NPI:1003509001
Name:SAN GABRIEL VALLEY AUDIOLOGY AND HEARING AIDS
Entity Type:Organization
Organization Name:SAN GABRIEL VALLEY AUDIOLOGY AND HEARING AIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:626-485-2634
Mailing Address - Street 1:1700 W CAMERON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2718
Mailing Address - Country:US
Mailing Address - Phone:626-485-2634
Mailing Address - Fax:
Practice Address - Street 1:1700 W CAMERON AVE STE 110
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2718
Practice Address - Country:US
Practice Address - Phone:626-485-2634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology AssistantGroup - Single Specialty