Provider Demographics
NPI:1881686905
Name:SAN DIEGO HEARING CENTER INC
Entity Type:Organization
Organization Name:SAN DIEGO HEARING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BLANCHE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BLACKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:858-279-3277
Mailing Address - Street 1:4282 GENESEE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4946
Mailing Address - Country:US
Mailing Address - Phone:858-279-3277
Mailing Address - Fax:858-279-3281
Practice Address - Street 1:4282 GENESEE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117
Practice Address - Country:US
Practice Address - Phone:858-279-3277
Practice Address - Fax:858-279-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1291231H00000X
CA332S00000X
CAHA2797332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU0012910Medicaid
CAGAU0012910Medicaid
CAW18675Medicare ID - Type Unspecified