Provider Demographics
NPI:1528897899
Name:EARLES, LYDIA LEILANI (AUD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:LEILANI
Last Name:EARLES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 CAMINITO EL RINCON UNIT 39
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2548
Mailing Address - Country:US
Mailing Address - Phone:808-348-2099
Mailing Address - Fax:
Practice Address - Street 1:2390 FARADAY AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7216
Practice Address - Country:US
Practice Address - Phone:858-909-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3935231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist