Provider Demographics
NPI:1023569191
Name:TRINITY AZEVEDO BLITT, INC
Entity Type:Organization
Organization Name:TRINITY AZEVEDO BLITT, INC
Other - Org Name:RSF AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRINITY
Authorized Official - Middle Name:AZEVEDO
Authorized Official - Last Name:BLITT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:209-756-8456
Mailing Address - Street 1:1501 FRONT ST
Mailing Address - Street 2:UNIT 302
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2973
Mailing Address - Country:US
Mailing Address - Phone:209-756-8456
Mailing Address - Fax:
Practice Address - Street 1:6037 LA GRANADA
Practice Address - Street 2:SUITE D
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067
Practice Address - Country:US
Practice Address - Phone:858-759-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 3077237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB269060Medicare PIN