Provider Demographics
NPI:1154564300
Name:SOUTHERN CALIFORNIA AUDIOLOGY ASSOCIATES, INC
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA AUDIOLOGY ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEITERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:SCD
Authorized Official - Phone:310-360-0332
Mailing Address - Street 1:5525 ETIWANDA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6135
Mailing Address - Country:US
Mailing Address - Phone:818-578-5093
Mailing Address - Fax:888-405-0429
Practice Address - Street 1:5525 ETIWANDA AVE STE 201
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6135
Practice Address - Country:US
Practice Address - Phone:818-578-5093
Practice Address - Fax:888-405-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2631231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty