Provider Demographics
NPI:1164559456
Name:HEARING SCIENCE OF RANCHO CUCAMONGA, A PROFESSIONAL AUDIOLOGY CORPORAT
Entity Type:Organization
Organization Name:HEARING SCIENCE OF RANCHO CUCAMONGA, A PROFESSIONAL AUDIOLOGY CORPORAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-920-9906
Mailing Address - Street 1:8263 GROVE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3107
Mailing Address - Country:US
Mailing Address - Phone:909-920-9906
Mailing Address - Fax:909-920-4151
Practice Address - Street 1:8263 GROVE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3107
Practice Address - Country:US
Practice Address - Phone:909-920-9906
Practice Address - Fax:909-920-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1139237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU001030Medicaid
CABM458AOtherMEDICARE PTAN