Provider Demographics
NPI:1417030537
Name:PAUL JOHN DIETSCH
Entity Type:Organization
Organization Name:PAUL JOHN DIETSCH
Other - Org Name:OCEANSIDE HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DIETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:760-439-5755
Mailing Address - Street 1:2204 S EL CAMINO REAL STE 14
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6391
Mailing Address - Country:US
Mailing Address - Phone:760-439-5755
Mailing Address - Fax:760-439-5732
Practice Address - Street 1:2204 S EL CAMINO REAL STE 14
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6391
Practice Address - Country:US
Practice Address - Phone:760-439-5755
Practice Address - Fax:760-439-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA0000135237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75510ZMedicaid