Provider Demographics
NPI:1801986617
Name:PACIFIC AUDIOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:PACIFIC AUDIOLOGICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:909-989-4800
Mailing Address - Street 1:9033 BASELINE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1255
Mailing Address - Country:US
Mailing Address - Phone:909-989-4800
Mailing Address - Fax:909-989-4883
Practice Address - Street 1:9033 BASELINE RD
Practice Address - Street 2:SUITE F
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1255
Practice Address - Country:US
Practice Address - Phone:909-989-4800
Practice Address - Fax:909-989-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK445AOtherAUDIOLOGIST-MEDICARE PTAN
CAZZZ80458ZMedicaid