Provider Demographics
NPI:1407095987
Name:VALLEY HEARING SCREENING SERVICES
Entity Type:Organization
Organization Name:VALLEY HEARING SCREENING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-307-5193
Mailing Address - Street 1:PO BOX 4708
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-4708
Mailing Address - Country:US
Mailing Address - Phone:818-307-5193
Mailing Address - Fax:661-294-9227
Practice Address - Street 1:25115 AVENUE STANFORD
Practice Address - Street 2:SUITE A205
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1290
Practice Address - Country:US
Practice Address - Phone:818-307-5193
Practice Address - Fax:661-294-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002408540-0001-3293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory