Provider Demographics
NPI:1053678722
Name:BOZARTH, DAN W (HIS)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:W
Last Name:BOZARTH
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 JONES WAY STE 29
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1231
Mailing Address - Country:US
Mailing Address - Phone:805-581-4327
Mailing Address - Fax:805-583-4327
Practice Address - Street 1:2650 JONES WAY STE 29
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1231
Practice Address - Country:US
Practice Address - Phone:805-581-4327
Practice Address - Fax:805-583-4327
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7496237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist