Provider Demographics
NPI:1073754230
Name:HEARING AID SERVICES OF HOLLYWOOD INC
Entity Type:Organization
Organization Name:HEARING AID SERVICES OF HOLLYWOOD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:GRAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:323-463-7109
Mailing Address - Street 1:7080 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 814
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6935
Mailing Address - Country:US
Mailing Address - Phone:323-463-7109
Mailing Address - Fax:323-463-7707
Practice Address - Street 1:7080 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 814
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6935
Practice Address - Country:US
Practice Address - Phone:323-463-7109
Practice Address - Fax:323-463-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 362231H00000X
CAHA 1056237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0003620Medicaid
CAHA0010560Medicaid