NPIMap

Organization Active NPI

Mendocino Lake Audiology Inc.

  • Audiologist-Hearing Aid Fitter
  • Ukiah, CA
National Provider Identifier
1477797082
Registry record updated Apr 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Audiologist-Hearing Aid FitterTaxonomy code 237600000X
License
AU1445 Issued in CA
Legal business name
MENDOCINO LAKE AUDIOLOGY INC.
Practice address
756 S Dora St
Ukiah, CA 95482-5336
Phone
(707) 463-2966
Fax
(707) 463-2970
NPI assigned
Apr 27, 2009
Last updated
Apr 27, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Hubert R Fernande
Title
Cfo
Phone
(707) 463-2966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X AU1445 CA Primary

Addresses

Primary practice location

756 S Dora St
Ukiah, CA 95482-5336

Mailing address

756 S Dora St
Ukiah, CA 95482-5336
Phone (707) 463-2966

National Provider Directory

National Provider Directory

Locations

200 Lakeport Blvd
Ste A
Lakeport, CA 95453
Phone (707) 263-9428

756 S Dora St
Ukiah, CA 95482
Phone (707) 367-0172

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240790400000",
    "number": "1477797082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "756 S DORA ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825336",
            "telephone_number": "707-463-2966",
            "fax_number": "707-463-2970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "756 S DORA ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825336",
            "telephone_number": "707-463-2966",
            "fax_number": "707-463-2970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOCINO LAKE AUDIOLOGY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-27",
        "last_updated": "2009-04-27",
        "status": "A",
        "authorized_official_last_name": "FERNANDE",
        "authorized_official_first_name": "HUBERT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "707-463-2966",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "CA",
            "license": "AU1445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.