Provider Demographics
NPI:1619990488
Name:HEARING SERVICES OF ANTIOCH A PROFESSIONAL AUDIOLOGY CORPRATION
Entity Type:Organization
Organization Name:HEARING SERVICES OF ANTIOCH A PROFESSIONAL AUDIOLOGY CORPRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:GARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:925-778-3298
Mailing Address - Street 1:4045 LONE TREE WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6200
Mailing Address - Country:US
Mailing Address - Phone:925-778-3298
Mailing Address - Fax:925-778-0937
Practice Address - Street 1:4045 LONE TREE WAY
Practice Address - Street 2:SUITE D
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6200
Practice Address - Country:US
Practice Address - Phone:925-778-3298
Practice Address - Fax:925-778-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU473231H00000X
CAHA3465237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0004730Medicaid
CAZZZ45902ZMedicare ID - Type UnspecifiedPROVIDER NUMBER