Provider Demographics
NPI:1669724761
Name:ACTIVE HEARING & BALANCE CENTER INC
Entity type:Organization
Organization Name:ACTIVE HEARING & BALANCE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:361-986-0886
Mailing Address - Street 1:4833 S. STAPLES
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-986-0882
Mailing Address - Fax:361-986-0889
Practice Address - Street 1:4833 S. STAPLES
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-986-0882
Practice Address - Fax:361-986-0889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE HEARING & BALANCE CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-12
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51191237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty