Provider Demographics
NPI:1114966132
Name:PROFESSIONAL HEARING ASSOCIATES INC
Entity type:Organization
Organization Name:PROFESSIONAL HEARING ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:A.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:COLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:STASEK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:760-489-6901
Mailing Address - Street 1:1045 E VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4618
Mailing Address - Country:US
Mailing Address - Phone:760-489-6901
Mailing Address - Fax:760-489-1694
Practice Address - Street 1:1045 E VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4618
Practice Address - Country:US
Practice Address - Phone:760-489-6901
Practice Address - Fax:760-489-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0015170Medicaid
CAAUD778Medicare ID - Type Unspecified