Provider Demographics
NPI:1972798882
Name:STANOWSKI, RUDY HENRY (HAD1347)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:HENRY
Last Name:STANOWSKI
Suffix:
Gender:M
Credentials:HAD1347
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19523 E CYPRESS ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2066
Mailing Address - Country:US
Mailing Address - Phone:626-915-0780
Mailing Address - Fax:626-915-0780
Practice Address - Street 1:19523 E CYPRESS ST
Practice Address - Street 2:SUITE D
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2066
Practice Address - Country:US
Practice Address - Phone:626-915-0780
Practice Address - Fax:626-915-0780
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1347237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist