Provider Demographics
NPI:1497856512
Name:GOLDEN STATE AUDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:GOLDEN STATE AUDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL AUDIOLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VON PINNON
Authorized Official - Suffix:
Authorized Official - Credentials:ED,D, CCC-A
Authorized Official - Phone:408-365-5700
Mailing Address - Street 1:5725 WINFIELD BLVD
Mailing Address - Street 2:#3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2430
Mailing Address - Country:US
Mailing Address - Phone:408-365-5700
Mailing Address - Fax:408-365-5702
Practice Address - Street 1:1275 LINCOLN AVE
Practice Address - Street 2:SUITE 6B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3049
Practice Address - Country:US
Practice Address - Phone:408-294-0644
Practice Address - Fax:408-294-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU00417231H00000X
CAHA989237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty