Provider Demographics
NPI:1487426144
Name:CALIFORNIA STATE UNIVERSITY, LOS ANGELES
Entity type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY, LOS ANGELES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUD PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:IVORY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-521-3386
Mailing Address - Street 1:1000 S FREMONT AVE UNIT 32
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8866
Mailing Address - Country:US
Mailing Address - Phone:626-382-0254
Mailing Address - Fax:626-382-0256
Practice Address - Street 1:HEARING & BALANCE CENTER, LOWER LEVEL B1, SUITE B-10200
Practice Address - Street 2:1000 S. FREMONT AVENUE
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8866
Practice Address - Country:US
Practice Address - Phone:626-382-0254
Practice Address - Fax:626-382-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech