Provider Demographics
NPI:1104182690
Name:PACIFIC COAST HEARING AID CENTERS
Entity Type:Organization
Organization Name:PACIFIC COAST HEARING AID CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:PELLANDINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-962-9230
Mailing Address - Street 1:347 CYPRESS ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5458
Mailing Address - Country:US
Mailing Address - Phone:707-962-9230
Mailing Address - Fax:707-962-9230
Practice Address - Street 1:347 CYPRESS ST
Practice Address - Street 2:SUITE D
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5458
Practice Address - Country:US
Practice Address - Phone:707-962-9230
Practice Address - Fax:707-962-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2892332B00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA2892OtherHEARING AID DISPENSERS LICENSE