Provider Demographics
NPI:1245789239
Name:TINNITUS AND AUDIOLOGY CLINIC OF SILICON VALLEY
Entity Type:Organization
Organization Name:TINNITUS AND AUDIOLOGY CLINIC OF SILICON VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARNI
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:NOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:408-540-7180
Mailing Address - Street 1:340 DARDANELLI LN
Mailing Address - Street 2:STE. 22C
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1418
Mailing Address - Country:US
Mailing Address - Phone:408-540-7180
Mailing Address - Fax:408-599-3013
Practice Address - Street 1:340 DARDANELLI LN
Practice Address - Street 2:STE. 22C
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1418
Practice Address - Country:US
Practice Address - Phone:408-540-7180
Practice Address - Fax:408-599-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2085231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty