Provider Demographics
NPI:1134220064
Name:MORAN, BOGART JOEL (HEARING AID DISPENSE)
Entity type:Individual
Prefix:MR
First Name:BOGART
Middle Name:JOEL
Last Name:MORAN
Suffix:
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 1/2 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6043
Mailing Address - Country:US
Mailing Address - Phone:323-588-0742
Mailing Address - Fax:323-588-6805
Practice Address - Street 1:7635 1/2 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6043
Practice Address - Country:US
Practice Address - Phone:323-588-0742
Practice Address - Fax:323-588-6805
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 3004237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist