Provider Demographics
NPI:1760635023
Name:SOUTHERN ARIZONA HEARING AND BALANCE, L.L.C.
Entity Type:Organization
Organization Name:SOUTHERN ARIZONA HEARING AND BALANCE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRESENT
Authorized Official - Middle Name:O
Authorized Official - Last Name:GURTLER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:520-459-0688
Mailing Address - Street 1:2460 E WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2841
Mailing Address - Country:US
Mailing Address - Phone:520-459-0688
Mailing Address - Fax:520-459-0689
Practice Address - Street 1:2460 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2841
Practice Address - Country:US
Practice Address - Phone:520-459-0688
Practice Address - Fax:520-459-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA-1304261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech