Provider Demographics
NPI:1639317936
Name:STANOWSKI, BEN (HA4010)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:STANOWSKI
Suffix:
Gender:M
Credentials:HA4010
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11340 MT VIEW AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3858
Mailing Address - Country:US
Mailing Address - Phone:909-796-2354
Mailing Address - Fax:909-796-2357
Practice Address - Street 1:11340 MT VIEW AVE STE A
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3858
Practice Address - Country:US
Practice Address - Phone:909-796-2354
Practice Address - Fax:909-796-2357
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA4010237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist