Provider Demographics
NPI:1780022624
Name:SOUTH BAY HEARING & BALANCE CENTER
Entity Type:Organization
Organization Name:SOUTH BAY HEARING & BALANCE CENTER
Other - Org Name:MISSION AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:AU D
Authorized Official - Phone:310-375-6161
Mailing Address - Street 1:3734 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2513
Mailing Address - Country:US
Mailing Address - Phone:310-375-6161
Mailing Address - Fax:310-375-6101
Practice Address - Street 1:26302 LA PAZ RD STE 107
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5327
Practice Address - Country:US
Practice Address - Phone:949-855-7898
Practice Address - Fax:949-855-1074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH BAY HEARING & BALANCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-13
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU645237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU645Medicare UPIN