Provider Demographics
NPI:1538484233
Name:FIDELITY HEARING CENTER, INC.
Entity Type:Organization
Organization Name:FIDELITY HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEKRIEK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:562-926-6066
Mailing Address - Street 1:13079 ARTESIA BLVD.
Mailing Address - Street 2:B-104
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1370
Mailing Address - Country:US
Mailing Address - Phone:562-926-6066
Mailing Address - Fax:562-926-6069
Practice Address - Street 1:13079 ARTESIA BLVD.
Practice Address - Street 2:B-104
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1370
Practice Address - Country:US
Practice Address - Phone:562-926-6066
Practice Address - Fax:562-926-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2070237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty