Provider Demographics
NPI:1457491797
Name:MUSSON, DONALD CLIFFORD (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CLIFFORD
Last Name:MUSSON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:MR
Other - First Name:DON
Other - Middle Name:C
Other - Last Name:MUSSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:504 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3274
Mailing Address - Country:US
Mailing Address - Phone:559-781-1962
Mailing Address - Fax:559-684-0836
Practice Address - Street 1:504 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3274
Practice Address - Country:US
Practice Address - Phone:559-781-1962
Practice Address - Fax:559-684-0836
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2796237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0027960Medicaid
CAHA2796OtherLICENSE #