Provider Demographics
NPI:1407909062
Name:PACIFIC HEARING CLINIC
Entity Type:Organization
Organization Name:PACIFIC HEARING CLINIC
Other - Org Name:PACIFIC HEARING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:650-941-0664
Mailing Address - Street 1:496 1ST ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-3676
Mailing Address - Country:US
Mailing Address - Phone:650-941-0664
Mailing Address - Fax:650-941-2892
Practice Address - Street 1:496 1ST ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-3676
Practice Address - Country:US
Practice Address - Phone:650-941-0664
Practice Address - Fax:650-941-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZA 004237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05599ZMedicare PIN