Provider Demographics
NPI:1760877997
Name:SUPERTONE HEARING AID CENTER
Entity Type:Organization
Organization Name:SUPERTONE HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:MIMI
Authorized Official - Last Name:SHALEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-712-0001
Mailing Address - Street 1:6700 FALLBROOK AVE
Mailing Address - Street 2:SUITE 294
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3530
Mailing Address - Country:US
Mailing Address - Phone:818-712-0001
Mailing Address - Fax:818-712-9839
Practice Address - Street 1:6700 FALLBROOK AVE
Practice Address - Street 2:SUITE 294
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3530
Practice Address - Country:US
Practice Address - Phone:818-712-0001
Practice Address - Fax:818-712-9839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2113237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0021130Medicaid