Provider Demographics
NPI:1699549329
Name:CRYSTAL CLEAR HEARING CENTER INC
Entity type:Organization
Organization Name:CRYSTAL CLEAR HEARING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:714-630-7800
Mailing Address - Street 1:101 S KRAEMER BLVD STE 236
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6102
Mailing Address - Country:US
Mailing Address - Phone:714-630-7800
Mailing Address - Fax:
Practice Address - Street 1:101 S KRAEMER BLVD STE 236
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6102
Practice Address - Country:US
Practice Address - Phone:714-630-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty