Provider Demographics
NPI:1639477029
Name:AC AUDIOLOGY LLC
Entity Type:Organization
Organization Name:AC AUDIOLOGY LLC
Other - Org Name:SONUS SF0012
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIA-IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBALLO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:702-204-1123
Mailing Address - Street 1:8301 ARLINGTON BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2902
Mailing Address - Country:US
Mailing Address - Phone:703-204-1123
Mailing Address - Fax:703-204-1143
Practice Address - Street 1:8301 ARLINGTON BLVD
Practice Address - Street 2:STE 302
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-204-1123
Practice Address - Fax:703-204-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty