Provider Demographics
NPI:1972754448
Name:PHS SAN CLEMENTE, INC.
Entity Type:Organization
Organization Name:PHS SAN CLEMENTE, INC.
Other - Org Name:HEARING CENTER OF SAN CLEMENTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:949-364-4361
Mailing Address - Street 1:675 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2835
Mailing Address - Country:US
Mailing Address - Phone:949-496-2307
Mailing Address - Fax:949-496-8688
Practice Address - Street 1:675 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 420
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2835
Practice Address - Country:US
Practice Address - Phone:949-496-2307
Practice Address - Fax:949-496-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty