Provider Demographics
NPI:1073867701
Name:LIFESTYLE HEARING AID SOLUTIONS
Entity Type:Organization
Organization Name:LIFESTYLE HEARING AID SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:NUENT
Authorized Official - Suffix:
Authorized Official - Credentials:AUDIOLOGIST
Authorized Official - Phone:909-593-0550
Mailing Address - Street 1:1965 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3502
Mailing Address - Country:US
Mailing Address - Phone:909-583-0550
Mailing Address - Fax:909-593-0551
Practice Address - Street 1:1965 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3502
Practice Address - Country:US
Practice Address - Phone:909-583-0550
Practice Address - Fax:909-593-0551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESTYLE HEARING AID SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1200005070231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty