Provider Demographics
NPI:1932440773
Name:TINNITUS AND AUDIOLOGY CENTER OF SOUTHERN CALIFORNIA INC.
Entity Type:Organization
Organization Name:TINNITUS AND AUDIOLOGY CENTER OF SOUTHERN CALIFORNIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SARMIENTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-259-1687
Mailing Address - Street 1:23033 LYONS AVE
Mailing Address - Street 2:#4
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2727
Mailing Address - Country:US
Mailing Address - Phone:661-259-1687
Mailing Address - Fax:661-259-9684
Practice Address - Street 1:23033 LYONS AVE
Practice Address - Street 2:#4
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2727
Practice Address - Country:US
Practice Address - Phone:661-259-1687
Practice Address - Fax:661-259-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAUD444231H00000X, 231HA2400X, 235500000X
CAHA1195237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA1195OtherHEARING AID DISPENCING
CAAUD444Medicare PIN