Provider Demographics
NPI:1396892568
Name:CENTRAL COAST AUDIOLOGY INCORPORATED
Entity type:Organization
Organization Name:CENTRAL COAST AUDIOLOGY INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:TYBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-449-1600
Mailing Address - Street 1:307 MAIN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2705
Mailing Address - Country:US
Mailing Address - Phone:831-449-1600
Mailing Address - Fax:831-449-1661
Practice Address - Street 1:917 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2912
Practice Address - Country:US
Practice Address - Phone:831-643-1600
Practice Address - Fax:831-643-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1595231H00000X
CAHA3460237600000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU1595OtherAUDIOLOGY
CAHA3460OtherHEARING AIDS
CAHA3460OtherHEARING AIDS
OR113198Medicare PIN