Provider Demographics
NPI:1578592325
Name:WEST COAST HEARING & BALANCE CENTER
Entity Type:Organization
Organization Name:WEST COAST HEARING & BALANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, PHD
Authorized Official - Phone:310-477-5558
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:SUITE # 460
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-983-4214
Mailing Address - Fax:805-983-0463
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:SUITE # 460
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-983-4214
Practice Address - Fax:805-983-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW18144B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000992Medicaid
CAGAU000992Medicaid