Provider Demographics
NPI:1184235459
Name:AUDIOLOGY AND INTEGRATED PROFESSIONAL SERVICES, INC
Entity type:Organization
Organization Name:AUDIOLOGY AND INTEGRATED PROFESSIONAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-503-1700
Mailing Address - Street 1:17768 WIKA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1200
Mailing Address - Country:US
Mailing Address - Phone:760-503-1700
Mailing Address - Fax:760-503-1728
Practice Address - Street 1:17768 WIKA RD STE 200
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1200
Practice Address - Country:US
Practice Address - Phone:760-503-1700
Practice Address - Fax:760-503-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU1439OtherCALIFORNIA AUDIOLOGY LICENSURE