Healthcare Provider Details

I. General information

NPI: 1689098055
Provider Name (Legal Business Name): JONATHAN LIPSCHUTZ M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 SAN PABLO AVE
BERKELEY CA
94702-2240
US

IV. Provider business mailing address

2748 SAN PABLO AVE
BERKELEY CA
94702-2240
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-0681
  • Fax: 510-841-0695
Mailing address:
  • Phone: 510-841-0681
  • Fax: 510-841-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU1771
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: