Provider Demographics
NPI:1508199449
Name:SOUTHERN CALIFORNIA AUDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA AUDIOLOGY ASSOCIATES
Other - Org Name:SOCAL HEARING AND BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEITERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:SCD
Authorized Official - Phone:310-360-0332
Mailing Address - Street 1:8500 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3121
Mailing Address - Country:US
Mailing Address - Phone:310-360-0332
Mailing Address - Fax:310-360-6891
Practice Address - Street 1:8500 WILSHIRE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3121
Practice Address - Country:US
Practice Address - Phone:310-360-0332
Practice Address - Fax:310-360-6891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN CALIFORNIA AUDIOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2631231H00000X
CAHA7382237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty