Provider Demographics
NPI:1669512208
Name:WARNER, COURTLANDT C (MA)
Entity type:Individual
Prefix:MR
First Name:COURTLANDT
Middle Name:C
Last Name:WARNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N SAN FERNANDO BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1208
Mailing Address - Country:US
Mailing Address - Phone:818-842-4069
Mailing Address - Fax:818-848-1616
Practice Address - Street 1:127 N SAN FERNANDO BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1208
Practice Address - Country:US
Practice Address - Phone:818-842-4069
Practice Address - Fax:818-848-1616
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2077231H00000X
CAHA2679237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0026790Medicaid
CAAU2077Medicare ID - Type Unspecified