Provider Demographics
NPI:1760527162
Name:MONARDI, LISA (AUD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MONARDI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:JASCHKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 SAN CLEMENTE DR STE D140
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1210
Mailing Address - Country:US
Mailing Address - Phone:415-927-1567
Mailing Address - Fax:415-329-1924
Practice Address - Street 1:45 SAN CLEMENTE DR STE D140
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925
Practice Address - Country:US
Practice Address - Phone:415-927-1567
Practice Address - Fax:415-329-1924
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1719231HA2500X, 235500000X, 237600000X, 231H00000X, 231HA2400X
CAHA3491237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20514ZMedicare ID - Type UnspecifiedINDIVIDUAL