Provider Demographics
NPI:1598854846
Name:RIVERVIEW HEARING SPEECH AND LANGUAGE CENTER
Entity Type:Organization
Organization Name:RIVERVIEW HEARING SPEECH AND LANGUAGE CENTER
Other - Org Name:AUDIOLOGICS / RIVERVIEW HEARING, SPEECH & LANGUAGE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASIL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:562-439-4539
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2624
Mailing Address - Country:US
Mailing Address - Phone:562-439-4539
Mailing Address - Fax:562-439-2232
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2624
Practice Address - Country:US
Practice Address - Phone:562-439-4539
Practice Address - Fax:562-439-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU220231H00000X
CAAU1873231H00000X
CAAU2051231H00000X
CAAU1889231H00000X
CAAU2193231H00000X
CASP1845235Z00000X
CARPE3748235Z00000X
CAHA1140237600000X
CAHA3913237600000X
CAHA3791237600000X
CAHA5059237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79958ZOtherMEDI-CAL GROUP NUMBER
CAAUD007Medicare ID - Type Unspecified