Provider Demographics
NPI:1427263334
Name:HARBOR AUDIOLOGY, P.A.
Entity type:Organization
Organization Name:HARBOR AUDIOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:941-505-0400
Mailing Address - Street 1:100 MADRID BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950
Mailing Address - Country:US
Mailing Address - Phone:941-505-0400
Mailing Address - Fax:941-505-0022
Practice Address - Street 1:100 MADRID BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950
Practice Address - Country:US
Practice Address - Phone:941-505-0400
Practice Address - Fax:941-505-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ8079OtherBLUE CROSS BLUE SHIELD
FLJ8079OtherBLUE CROSS BLUE SHIELD