Provider Demographics
NPI:1144618166
Name:ANGELICA AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:ANGELICA AUDIOLOGY, LLC
Other - Org Name:AUDIO ACOUSTICS HEARING CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:575-623-8474
Mailing Address - Street 1:1000 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3038
Mailing Address - Country:US
Mailing Address - Phone:575-623-8474
Mailing Address - Fax:575-623-8220
Practice Address - Street 1:1000 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3038
Practice Address - Country:US
Practice Address - Phone:575-623-8474
Practice Address - Fax:575-623-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4960237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty