Provider Demographics
NPI:1558536565
Name:MISSION AUDIOLOGY, INC
Entity Type:Organization
Organization Name:MISSION AUDIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIO;OGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, FAAA
Authorized Official - Phone:949-855-7898
Mailing Address - Street 1:26302 LA PAZ RD
Mailing Address - Street 2:107
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-855-7898
Mailing Address - Fax:949-855-1074
Practice Address - Street 1:26302 LA PAZ RD
Practice Address - Street 2:107
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-855-7898
Practice Address - Fax:949-855-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU752Medicare PIN