Provider Demographics
NPI:1598966434
Name:LIFESTYLE HEARING AID SOLUTIONS INC.
Entity Type:Organization
Organization Name:LIFESTYLE HEARING AID SOLUTIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-593-0550
Mailing Address - Street 1:1965 FOOTHILL BLVD
Mailing Address - Street 2:SUITE R
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3502
Mailing Address - Country:US
Mailing Address - Phone:909-593-0550
Mailing Address - Fax:909-593-0551
Practice Address - Street 1:1965 FOOTHILL BLVD STE R
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3502
Practice Address - Country:US
Practice Address - Phone:909-593-0550
Practice Address - Fax:909-593-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA-6009237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty