Provider Demographics
NPI:1386934305
Name:CONEJO HEARING CENTER, INC.
Entity type:Organization
Organization Name:CONEJO HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-991-3800
Mailing Address - Street 1:5655 LINDERO CANYON RD STE 503
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-7358
Mailing Address - Country:US
Mailing Address - Phone:818-991-3800
Mailing Address - Fax:818-991-3870
Practice Address - Street 1:5655 LINDERO CANYON RD STE 503
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-7358
Practice Address - Country:US
Practice Address - Phone:818-991-3800
Practice Address - Fax:818-991-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2027237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty