Provider Demographics
NPI:1366607913
Name:COAST HEARING SERVICES, A PROFESSIONAL CORP
Entity type:Organization
Organization Name:COAST HEARING SERVICES, A PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:FELKER
Authorized Official - Last Name:CODY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:949-675-3833
Mailing Address - Street 1:3545 E COAST HWY
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2404
Mailing Address - Country:US
Mailing Address - Phone:949-675-3833
Mailing Address - Fax:949-723-4822
Practice Address - Street 1:3545 E COAST HWY
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2404
Practice Address - Country:US
Practice Address - Phone:949-675-3833
Practice Address - Fax:949-723-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2780237600000X
CAAU1223231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH0ZYMedicare PIN