Provider Demographics
NPI:1437150190
Name:COLEMAN, JOHN RAYMOND (AUD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
Last Name:COLEMAN
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 1:26726 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6364
Mailing Address - Country:US
Mailing Address - Phone:949-364-4361
Mailing Address - Fax:949-364-7124
Practice Address - Street 1:26726 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6364
Practice Address - Country:US
Practice Address - Phone:949-364-4361
Practice Address - Fax:949-364-7124
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU683231H00000X
CAHA1691237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU683OtherSTATE AUDIOLOGY LICENSE
CAAU0006830OtherMEDI-CAL #
CAHA 1691OtherHEARING AID DISPENSING
CAAM896YOtherPTAN
CAAM896ZOtherINDIVIDUAL PTAN
CAW8109OtherGROUP PTAN
CAW15940OtherGROUP PTAN