Provider Demographics
NPI:1366508111
Name:MA, JOANNE (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 S VERMONT AVE # 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006
Mailing Address - Country:US
Mailing Address - Phone:213-368-6300
Mailing Address - Fax:213-368-6303
Practice Address - Street 1:1058 S VERMONT AVE # 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:213-368-6300
Practice Address - Fax:213-368-6303
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1380237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0013800Medicaid