Provider Demographics
NPI:1376763102
Name:AUDIOLOGY CENTER OF LOS ANGELES
Entity Type:Organization
Organization Name:AUDIOLOGY CENTER OF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:323-851-6556
Mailing Address - Street 1:PO BOX 480184
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1184
Mailing Address - Country:US
Mailing Address - Phone:323-851-6556
Mailing Address - Fax:323-851-6593
Practice Address - Street 1:1728 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2138
Practice Address - Country:US
Practice Address - Phone:323-851-6556
Practice Address - Fax:232-851-6593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU64237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU64OtherSTATE LICENSE