Provider Demographics
NPI:1043434038
Name:AUDIOLOGY CONSULTANTS OF SO. CA INC
Entity type:Organization
Organization Name:AUDIOLOGY CONSULTANTS OF SO. CA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-943-7892
Mailing Address - Street 1:PO BOX 571154
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-1154
Mailing Address - Country:US
Mailing Address - Phone:818-943-7892
Mailing Address - Fax:818-244-8532
Practice Address - Street 1:3122 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2533
Practice Address - Country:US
Practice Address - Phone:818-943-7892
Practice Address - Fax:818-244-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2092231H00000X
CAHA4022237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043434038Medicaid
CA1043434038Medicaid