Provider Demographics
NPI:1457418345
Name:COLUCCI, DENNIS ALDO (AUD, MA, ABA)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ALDO
Last Name:COLUCCI
Suffix:
Gender:M
Credentials:AUD, MA, ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32565 GOLDEN LANTERN ST
Mailing Address - Street 2:SUITE B#117
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3261
Mailing Address - Country:US
Mailing Address - Phone:949-230-1976
Mailing Address - Fax:949-388-0932
Practice Address - Street 1:24672 SAN JUAN AVE STE 104
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2837
Practice Address - Country:US
Practice Address - Phone:949-230-1976
Practice Address - Fax:949-388-0932
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU348231H00000X
CAHA1026237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU348OtherSTATE LICENSE
CAAU348OtherSTATE LICENSE
CAAU348OtherSTATE LICENSE