Healthcare Provider Details

I. General information

NPI: 1699587915
Provider Name (Legal Business Name): SOUMYA VENKITAKRISHNAN AUD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 CIVIC CT
CONCORD CA
94520-7914
US

IV. Provider business mailing address

408 TIMBERLINE CT
PLEASANT HILL CA
94523-3191
US

V. Phone/Fax

Practice location:
  • Phone: 844-319-1150
  • Fax:
Mailing address:
  • Phone: 319-400-3878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3734
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number9061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: