Provider Demographics
NPI:1801044698
Name:LOS ANGELES AUDIOLOGY GROUP, INC.
Entity Type:Organization
Organization Name:LOS ANGELES AUDIOLOGY GROUP, INC.
Other - Org Name:LOS ANGELES HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DENZIL
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:213-386-6108
Mailing Address - Street 1:3875 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3205
Mailing Address - Country:US
Mailing Address - Phone:213-386-6108
Mailing Address - Fax:213-386-6182
Practice Address - Street 1:3875 WILSHIRE BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3205
Practice Address - Country:US
Practice Address - Phone:213-386-6108
Practice Address - Fax:213-386-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1730237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0017300Medicaid
CAAU0017302Medicaid
CA1710993993OtherINDIVIDUAL NPI
CAAU0017301Medicaid
CAAU0017301Medicaid