Organization
MALCOLM GLEN CORP
Active
Other names
Miracle Ear Ontario
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY M JONES HIS (CFO)
(909) 986-9635
Entity
Organization
Contact information
Practice address
528 NO PALM AVE, ONTARIO, CA 91762-3218
(909) 986-9635
(909) 391-5873
Mailing address
528 NO PALM AVE, ONTARIO, CA 91762-3218
(909) 986-9635
(909) 391-5873
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
HA3682
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HA0036820
—
CA
01
—
ZZZ04705Z
BLUE SHIELD
CA
Enumeration date
08/04/2006
Last updated
08/22/2020
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