Provider Demographics
NPI:1902020894
Name:FITZGIBBONS AND ASSOCIATES
Entity Type:Organization
Organization Name:FITZGIBBONS AND ASSOCIATES
Other - Org Name:DBA HEARING SCIENCE OF WALNUT CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FITZGIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-A
Authorized Official - Phone:925-933-2699
Mailing Address - Street 1:1776 YGNACIO VALLEY ROAD
Mailing Address - Street 2:SUITE110
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-933-2699
Mailing Address - Fax:925-933-2797
Practice Address - Street 1:1776 YGNACIO VALLEY ROAD
Practice Address - Street 2:SUITE110
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-933-2699
Practice Address - Fax:925-933-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA3669OtherSTATE LICENSE
CAAU1722OtherSTATE LICENSE
CAZZZ179989ZMedicare PIN