Provider Demographics
NPI:1972800860
Name:MENIFEE HEARING AID LLC
Entity Type:Organization
Organization Name:MENIFEE HEARING AID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING AID SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JESTER
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:951-246-8229
Mailing Address - Street 1:26010 MCCALL BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-1983
Mailing Address - Country:US
Mailing Address - Phone:951-246-8229
Mailing Address - Fax:951-246-8278
Practice Address - Street 1:26010 MCCALL BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-1983
Practice Address - Country:US
Practice Address - Phone:951-246-8229
Practice Address - Fax:951-246-8278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1572332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80008ZOtherSTATE OF CA