Provider Demographics
NPI:1659777977
Name:CARL, ANJA (AUD)
Entity Type:Individual
Prefix:
First Name:ANJA
Middle Name:
Last Name:CARL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ANJA
Other - Middle Name:
Other - Last Name:ARKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:446 OLD NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4246
Mailing Address - Country:US
Mailing Address - Phone:949-631-4327
Mailing Address - Fax:
Practice Address - Street 1:446 OLD NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4246
Practice Address - Country:US
Practice Address - Phone:949-631-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2626237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2926OtherSTATE LICENSE