Provider Demographics
NPI:1417113531
Name:DEKRIEK, DAVID J (AUD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:DEKRIEK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13079 ARTESIA BLVD STE B104
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1387
Mailing Address - Country:US
Mailing Address - Phone:562-926-6066
Mailing Address - Fax:562-926-6069
Practice Address - Street 1:13079 ARTESIA BLVD STE B104
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1387
Practice Address - Country:US
Practice Address - Phone:562-926-6066
Practice Address - Fax:562-926-6069
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2070237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter