Provider Demographics
NPI:1437488616
Name:EGHTERAFI, SOROUSH NAJAFABADI (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:
First Name:SOROUSH
Middle Name:NAJAFABADI
Last Name:EGHTERAFI
Suffix:
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5860
Mailing Address - Country:US
Mailing Address - Phone:562-728-4324
Mailing Address - Fax:562-728-8864
Practice Address - Street 1:5290 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5860
Practice Address - Country:US
Practice Address - Phone:562-728-4324
Practice Address - Fax:562-728-8864
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7566237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA7566OtherHEARING AID DISPENSERS BUREAU