Provider Demographics
NPI:1275888976
Name:PETER J. MARINCOVICH
Entity Type:Organization
Organization Name:PETER J. MARINCOVICH
Other - Org Name:AUDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARINCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-A
Authorized Official - Phone:707-523-4740
Mailing Address - Street 1:1111 SONOMA AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4819
Mailing Address - Country:US
Mailing Address - Phone:707-523-4740
Mailing Address - Fax:707-523-0231
Practice Address - Street 1:45080 LITTLE LAKE ST
Practice Address - Street 2:
Practice Address - City:MENDOCINO
Practice Address - State:CA
Practice Address - Zip Code:95460
Practice Address - Country:US
Practice Address - Phone:707-937-4667
Practice Address - Fax:707-937-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU758261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech