Provider Demographics
NPI:1043434749
Name:AUDIOLOGY CENTER OF LOS ANGELES
Entity Type:Organization
Organization Name:AUDIOLOGY CENTER OF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-851-6556
Mailing Address - Street 1:6350 W RAMSEY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3062
Mailing Address - Country:US
Mailing Address - Phone:323-851-6556
Mailing Address - Fax:323-851-6593
Practice Address - Street 1:6350 W RAMSEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3062
Practice Address - Country:US
Practice Address - Phone:323-851-6556
Practice Address - Fax:323-851-6593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU64237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU64OtherSTATE LICENSE