Provider Demographics
NPI:1295282630
Name:ARLINGTON HEARING AID CENTER
Entity type:Organization
Organization Name:ARLINGTON HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:FUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-688-7700
Mailing Address - Street 1:3700 VAN BUREN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0316
Mailing Address - Country:US
Mailing Address - Phone:951-688-7700
Mailing Address - Fax:951-688-7757
Practice Address - Street 1:3700 VAN BUREN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-0316
Practice Address - Country:US
Practice Address - Phone:951-688-7700
Practice Address - Fax:951-688-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3311237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770626806Medicaid