Provider Demographics
NPI:1063630614
Name:FJS HEARING PROFESSIONALS
Entity Type:Organization
Organization Name:FJS HEARING PROFESSIONALS
Other - Org Name:MIRACLE EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-225-4522
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-0369
Mailing Address - Country:US
Mailing Address - Phone:909-986-9635
Mailing Address - Fax:909-391-5873
Practice Address - Street 1:19083 BEAR VALLEY RD # 3
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-2719
Practice Address - Country:US
Practice Address - Phone:760-240-5700
Practice Address - Fax:760-240-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty