Provider Demographics
NPI:1568947430
Name:HARBOR HEARING SERVICES, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HARBOR HEARING SERVICES, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:424-570-0117
Mailing Address - Street 1:600 MONTEREY BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4582
Mailing Address - Country:US
Mailing Address - Phone:479-459-2261
Mailing Address - Fax:
Practice Address - Street 1:1360 W 6TH ST STE 243
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3589
Practice Address - Country:US
Practice Address - Phone:424-570-0117
Practice Address - Fax:424-570-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty