Provider Demographics
NPI:1972670008
Name:AA HEARING AIDS CENTER
Entity Type:Organization
Organization Name:AA HEARING AIDS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BA - BCHIS
Authorized Official - Phone:657-859-6172
Mailing Address - Street 1:1001 AVENIDA PICO STE. C-602
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-7053
Mailing Address - Country:US
Mailing Address - Phone:657-859-6172
Mailing Address - Fax:657-859-6172
Practice Address - Street 1:24191 PASEO DE VALENCIA STE. C
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-6957
Practice Address - Country:US
Practice Address - Phone:959-855-6658
Practice Address - Fax:949-855-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA0018650332B00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0018650Medicaid