Provider Demographics
NPI:1629592043
Name:SOUTH COAST HEARING SPECIALIST
Entity Type:Organization
Organization Name:SOUTH COAST HEARING SPECIALIST
Other - Org Name:SOUTHCOASTHEARINGSPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:949-558-8035
Mailing Address - Street 1:30532 MIRANDELA LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2346
Mailing Address - Country:US
Mailing Address - Phone:949-558-8035
Mailing Address - Fax:949-607-4400
Practice Address - Street 1:30030 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2046
Practice Address - Country:US
Practice Address - Phone:949-558-8035
Practice Address - Fax:949-607-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU350261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID