Provider Demographics
NPI:1396947008
Name:ASSOCIATED SPECIALIST IN HEARING DISORDERS HEARING AIDS
Entity type:Organization
Organization Name:ASSOCIATED SPECIALIST IN HEARING DISORDERS HEARING AIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOOGIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-778-0181
Mailing Address - Street 1:4440 BROCKTON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4026
Mailing Address - Country:US
Mailing Address - Phone:951-778-0181
Mailing Address - Fax:951-779-9818
Practice Address - Street 1:4440 BROCKTON AVE STE 210
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4026
Practice Address - Country:US
Practice Address - Phone:951-778-0181
Practice Address - Fax:951-779-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU592237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ94902ZMedicare ID - Type Unspecified