Provider Demographics
NPI:1366524936
Name:TEMECULA HEARING CENTER, INC.
Entity type:Organization
Organization Name:TEMECULA HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:STEJKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:951-296-5690
Mailing Address - Street 1:27349 JEFFERSON AVE
Mailing Address - Street 2:#112
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5634
Mailing Address - Country:US
Mailing Address - Phone:951-296-5690
Mailing Address - Fax:951-296-5693
Practice Address - Street 1:27349 JEFFERSON AVE
Practice Address - Street 2:#112
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5634
Practice Address - Country:US
Practice Address - Phone:951-296-5690
Practice Address - Fax:951-296-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU968231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4594692OtherAETNA ID#
CA4594692OtherAETNA ID#
CAZZZ25970ZMedicare ID - Type UnspecifiedMEMBER ID
CA=========OtherTAX ID NUMBER