Provider Demographics
NPI:1437230653
Name:ERICKSON, CHARLES E (HEARING AID SPECIALI)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:HEARING AID SPECIALI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72880 HIGHWAY 111
Mailing Address - Street 2:INSIDE SEARS
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3313
Mailing Address - Country:US
Mailing Address - Phone:760-568-1300
Mailing Address - Fax:760-568-1270
Practice Address - Street 1:73131 COUNTRY CLUB DR STE C5
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2339
Practice Address - Country:US
Practice Address - Phone:760-568-1300
Practice Address - Fax:760-568-1270
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7892237700000X, 237700000X
WAHA 601444950237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA 7892OtherCA-HEARING AID SPECIALI
CAHA 7892OtherCA-HEARING AID SPECIALI
ORHAS-P-723693OtherHEARING AID SPECIALIST, P