Healthcare Provider Details

I. General information

NPI: 1508746090
Provider Name (Legal Business Name): EMILY JO BERNARD AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SAN CLEMENTE DR STE D140
CORTE MADERA CA
94925-1210
US

IV. Provider business mailing address

45 SAN CLEMENTE DR STE D140
CORTE MADERA CA
94925-1210
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-1567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU4072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: