Provider Demographics
NPI:1386670602
Name:PACIFIC HEARING & BALANCE, INC.
Entity Type:Organization
Organization Name:PACIFIC HEARING & BALANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, PHD
Authorized Official - Phone:310-477-7281
Mailing Address - Street 1:4644 LINCOLN BLVD
Mailing Address - Street 2:SUITE # 409
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6313
Mailing Address - Country:US
Mailing Address - Phone:310-574-1116
Mailing Address - Fax:
Practice Address - Street 1:4644 LINCOLN BLVD
Practice Address - Street 2:SUITE # 409
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6313
Practice Address - Country:US
Practice Address - Phone:310-574-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW15955A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000793Medicaid
CAW15955AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER