Provider Demographics
NPI:1659787018
Name:WEST COAST AUDIOLOGY
Entity Type:Organization
Organization Name:WEST COAST AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-713-0017
Mailing Address - Street 1:7777 ALVARADO RD
Mailing Address - Street 2:STE 714
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-8216
Mailing Address - Country:US
Mailing Address - Phone:619-713-0017
Mailing Address - Fax:
Practice Address - Street 1:7777 ALVARADO RD
Practice Address - Street 2:STE 714
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-8216
Practice Address - Country:US
Practice Address - Phone:619-713-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2506237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty