Provider Demographics
NPI:1528241122
Name:HEARING HEALTH SPECIALTIES
Entity type:Organization
Organization Name:HEARING HEALTH SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:M.
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:DIETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID DISPENSE
Authorized Official - Phone:619-297-4145
Mailing Address - Street 1:3952 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3005
Mailing Address - Country:US
Mailing Address - Phone:619-297-4145
Mailing Address - Fax:619-297-0237
Practice Address - Street 1:3952 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3005
Practice Address - Country:US
Practice Address - Phone:619-297-4145
Practice Address - Fax:619-297-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU27231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAD000340Medicaid