Provider Demographics
NPI:1477598050
Name:WILLIAM DILES, INC.
Entity Type:Organization
Organization Name:WILLIAM DILES, INC.
Other - Org Name:KENWOOD HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:GENTRY
Authorized Official - Last Name:DILES
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:707-538-1000
Mailing Address - Street 1:55 MISSION AVE. #105
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409
Mailing Address - Country:US
Mailing Address - Phone:707-538-1000
Mailing Address - Fax:707-538-1013
Practice Address - Street 1:55 MISSION CIR. #105
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409
Practice Address - Country:US
Practice Address - Phone:707-538-1000
Practice Address - Fax:707-538-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU973231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAD000150Medicaid
CAHAD000150Medicaid