Provider Demographics
NPI:1639615735
Name:SAN LUIS OBISPO HEARING CENTER INC.
Entity Type:Organization
Organization Name:SAN LUIS OBISPO HEARING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:805-541-2368
Mailing Address - Street 1:895 AEROVISTA PL STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8725
Mailing Address - Country:US
Mailing Address - Phone:805-541-2368
Mailing Address - Fax:805-541-2553
Practice Address - Street 1:895 AEROVISTA PL STE 103
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8725
Practice Address - Country:US
Practice Address - Phone:805-541-2368
Practice Address - Fax:805-541-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty