Provider Demographics
NPI:1669992012
Name:DIGITAL HEARING LAB CORP
Entity type:Organization
Organization Name:DIGITAL HEARING LAB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING SPECIALIST
Authorized Official - Phone:352-988-0274
Mailing Address - Street 1:2738 EAGLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6269
Mailing Address - Country:US
Mailing Address - Phone:352-988-0274
Mailing Address - Fax:
Practice Address - Street 1:22 BROADWAY UNIT 109
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5408
Practice Address - Country:US
Practice Address - Phone:352-988-0274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016243300Medicaid