Provider Demographics
NPI:1457669905
Name:GOLD COAST AUDIOLOGY, INC.
Entity Type:Organization
Organization Name:GOLD COAST AUDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MAGNUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:805-620-0049
Mailing Address - Street 1:3418 LOMA VISTA RD.
Mailing Address - Street 2:STE. 5A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-620-0049
Mailing Address - Fax:805-620-0368
Practice Address - Street 1:3418 LOMA VISTA RD.
Practice Address - Street 2:STE. 5A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-620-0049
Practice Address - Fax:805-620-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU. 665237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAUD665Medicare PIN