Provider Demographics
NPI:1750661682
Name:ANDERSON, DAVID JEFFERY
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JEFFERY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24012 CALLE DE LA PLATA
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3621
Mailing Address - Country:US
Mailing Address - Phone:949-460-0617
Mailing Address - Fax:
Practice Address - Street 1:4300 W WACO DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7010
Practice Address - Country:US
Practice Address - Phone:254-399-0405
Practice Address - Fax:254-399-0316
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80820237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist