Provider Demographics
NPI:1356716708
Name:LONGEUAY, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LONGEUAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 E LA PALMA AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1700
Mailing Address - Country:US
Mailing Address - Phone:714-630-7800
Mailing Address - Fax:714-630-7803
Practice Address - Street 1:3855 E LA PALMA AVE STE 116
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1700
Practice Address - Country:US
Practice Address - Phone:714-630-7800
Practice Address - Fax:714-630-7803
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8028237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356716708OtherNPI TYPE 1
CA6900241Medicaid