Provider Demographics
NPI:1578600086
Name:HEAR WELL CENTER
Entity Type:Organization
Organization Name:HEAR WELL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF THE HEAR WELL CENTER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:AUD,PHD
Authorized Official - Phone:562-989-8101
Mailing Address - Street 1:3605 LONG BEACH BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4013
Mailing Address - Country:US
Mailing Address - Phone:562-989-8101
Mailing Address - Fax:562-989-8119
Practice Address - Street 1:3605 LONG BEACH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4013
Practice Address - Country:US
Practice Address - Phone:562-989-8101
Practice Address - Fax:562-989-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1232237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0012320Medicaid