Provider Demographics
NPI:1518153386
Name:MONROVIA HEARING AID CENTER
Entity Type:Organization
Organization Name:MONROVIA HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERTHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-357-3417
Mailing Address - Street 1:128 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2845
Mailing Address - Country:US
Mailing Address - Phone:626-357-3417
Mailing Address - Fax:626-359-5212
Practice Address - Street 1:128 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2845
Practice Address - Country:US
Practice Address - Phone:626-357-3417
Practice Address - Fax:626-359-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2710332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment