Provider Demographics
NPI:1982181350
Name:WESTSIDE AUDIOLOGY AND HEARING AID CENTER, LLC
Entity Type:Organization
Organization Name:WESTSIDE AUDIOLOGY AND HEARING AID CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:P
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-938-3777
Mailing Address - Street 1:5757 W THUNDERBIRD RD STE W301
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-5606
Mailing Address - Country:US
Mailing Address - Phone:602-938-3777
Mailing Address - Fax:602-547-0379
Practice Address - Street 1:5757 W THUNDERBIRD RD STE W301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-5606
Practice Address - Country:US
Practice Address - Phone:602-938-3777
Practice Address - Fax:602-547-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21267225237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty