Provider Demographics
NPI:1194941039
Name:MOJAVE DESERT HEARING AID CENTER
Entity type:Organization
Organization Name:MOJAVE DESERT HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERDISPENSER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-245-1653
Mailing Address - Street 1:15028 7TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3857
Mailing Address - Country:US
Mailing Address - Phone:760-245-1653
Mailing Address - Fax:
Practice Address - Street 1:15028 7TH ST STE 8
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3857
Practice Address - Country:US
Practice Address - Phone:760-245-1653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment