Provider Demographics
NPI:1629667290
Name:SEASIDE AUDIOLOGY VERTIGO & EAR SPECIALISTS INC
Entity Type:Organization
Organization Name:SEASIDE AUDIOLOGY VERTIGO & EAR SPECIALISTS INC
Other - Org Name:SEASIDE AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOODNIA
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:714-594-3302
Mailing Address - Street 1:18377 BEACH BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1349
Mailing Address - Country:US
Mailing Address - Phone:714-594-3302
Mailing Address - Fax:949-561-4484
Practice Address - Street 1:18377 BEACH BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1349
Practice Address - Country:US
Practice Address - Phone:714-594-3302
Practice Address - Fax:949-561-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932758539Medicaid