Healthcare Provider Details

I. General information

NPI: 1669473195
Provider Name (Legal Business Name): BETH L EHRLICH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date: 03/22/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

20101 LAKE CHABOT RD FL 3
CASTRO VALLEY CA
94546-5305
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 510-886-3400
  • Fax: 510-506-7729
Mailing address:
  • Phone: 510-866-3400
  • Fax: 510-506-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU433
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA1531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: