Provider Demographics
NPI:1851517098
Name:HEARING SERVICES OF MARIN
Entity Type:Organization
Organization Name:HEARING SERVICES OF MARIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-479-5675
Mailing Address - Street 1:2400 LAS GALLINAS AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1447
Mailing Address - Country:US
Mailing Address - Phone:415-479-5675
Mailing Address - Fax:415-479-1767
Practice Address - Street 1:2400 LAS GALLINAS AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1447
Practice Address - Country:US
Practice Address - Phone:415-479-5675
Practice Address - Fax:415-479-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1105237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA1105OtherSTATE LICENSE