1043484884 NPI number — SHARP HEARING INC.

Table of content: (NPI 1043484884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043484884 NPI number — SHARP HEARING INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARP HEARING INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043484884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 W GONZALES RD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93036-3303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-983-0444
Provider Business Mailing Address Fax Number:
805-278-6051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 W GONZALES RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93036-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-983-0444
Provider Business Practice Location Address Fax Number:
805-278-6051
Provider Enumeration Date:
04/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHARIM
Authorized Official First Name:
KAMBIZ
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-983-0444

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AU0020920 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: HA0041810 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043484884 . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1043484884 . This is a "BLUE SHIELD OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1043484884 . This is a "SCAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1043484884 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: GAU001050 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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