Provider Demographics
NPI:1669625729
Name:JOSEPH, MICHAL (AUD)
Entity Type:Individual
Prefix:MRS
First Name:MICHAL
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4460
Mailing Address - Country:US
Mailing Address - Phone:415-898-9361
Mailing Address - Fax:
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:UNIT 103
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2133
Practice Address - Country:US
Practice Address - Phone:415-461-9770
Practice Address - Fax:415-461-6744
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1976231H00000X
CAHA4052237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter