Provider Demographics
NPI:1922207596
Name:SUNCOAST LABORATORIES INC
Entity Type:Organization
Organization Name:SUNCOAST LABORATORIES INC
Other - Org Name:SUNCOAST HEARING AIDS & REPAIR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/HA
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:HA
Authorized Official - Phone:714-889-1582
Mailing Address - Street 1:P.O. BOX 6539
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90622
Mailing Address - Country:US
Mailing Address - Phone:714-889-1582
Mailing Address - Fax:714-889-1568
Practice Address - Street 1:7911 GARDEN GROVE BLVD.
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841
Practice Address - Country:US
Practice Address - Phone:714-889-1582
Practice Address - Fax:714-889-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2010-09-27
Deactivation Date:2008-08-11
Deactivation Code:
Reactivation Date:2010-08-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0039882Medicaid