Provider Demographics
NPI:1760886931
Name:ORANGE COUNTY PROFESSIONAL HEARING & SPEECH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ORANGE COUNTY PROFESSIONAL HEARING & SPEECH ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANE ITALIANE
Authorized Official - Suffix:
Authorized Official - Credentials:ACA, BC-HIS
Authorized Official - Phone:949-859-7553
Mailing Address - Street 1:24022 CALLE DE LA PLATA
Mailing Address - Street 2:SUITE 415
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3626
Mailing Address - Country:US
Mailing Address - Phone:949-859-7553
Mailing Address - Fax:949-859-9256
Practice Address - Street 1:24022 CALLE DE LA PLATA
Practice Address - Street 2:SUITE 415
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3626
Practice Address - Country:US
Practice Address - Phone:949-859-7553
Practice Address - Fax:949-859-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA0007560332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750367298OtherNPI - INDIVIDUAL