Provider Demographics
NPI:1124341300
Name:DESERT KNOLLS HEARING CENTER, INC
Entity type:Organization
Organization Name:DESERT KNOLLS HEARING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:760-242-2388
Mailing Address - Street 1:15995 TUSCOLA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2159
Mailing Address - Country:US
Mailing Address - Phone:760-242-2388
Mailing Address - Fax:760-242-2312
Practice Address - Street 1:15995 TUSCOLA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2159
Practice Address - Country:US
Practice Address - Phone:760-242-2388
Practice Address - Fax:760-242-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1897237700000X
CAAU315231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty