| Jenelle Helene Ezcurra Sandy, AUD | |
|
2074 Lake Tahoe Blvd, South Lake Tahoe, CA 96150-6407 | |
| (530) 318-4010 | |
| Not Available |
| Full Name | Jenelle Helene Ezcurra Sandy |
|---|---|
| Gender | Female |
| Speciality | Audiologist |
| Location | 2074 Lake Tahoe Blvd, South Lake Tahoe, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548548357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 231H00000X | Audiologist | 147001386 (Illinois) | Secondary |
| 231H00000X | Audiologist | A3154 (Nevada) | Secondary |
| 231H00000X | Audiologist | AU3526 (California) | Primary |
| Provider Name | Tahoe Family Hearing Clinic, Pc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1306595715 PECOS PAC ID: 2567838006 Enrollment ID: O20221025000316 |
| Mailing Address | Practice Location Address |
|---|---|
| Jenelle Helene Ezcurra Sandy, AUD 1285 Apache Ave # 306, South Lake Tahoe, CA 96155-7672 Ph: (530) 318-4010 | Jenelle Helene Ezcurra Sandy, AUD 2074 Lake Tahoe Blvd, South Lake Tahoe, CA 96150-6407 Ph: (530) 318-4010 |
Tahoe Family Hearing Clinic, Pc Audiologist Medicare: Medicare Enrolled Practice Location: 2074 Lake Tahoe Blvd, South Lake Tahoe, CA 96150 Phone: 530-318-4010 | |
Danielle Marie Knowlton, MA, FAAA Audiologist Medicare: Not Enrolled in Medicare Practice Location: 2169 South Ave, South Lake Tahoe, CA 96150 Phone: 530-543-5815 Fax: 530-544-3875 | |
Olivia Vinup, AU.D. Audiologist Medicare: Not Enrolled in Medicare Practice Location: 2074 Lake Tahoe Blvd Ste 9, South Lake Tahoe, CA 96150 Phone: 530-537-3344 |