Healthcare Provider Details

I. General information

NPI: 1518186220
Provider Name (Legal Business Name): EVOKED POTENTIAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 KNOCKASH HILL
SAN FRANCISCO CA
94127-1237
US

IV. Provider business mailing address

199 KNOCKASH HILL
SAN FRANCISCO CA
94127-1237
US

V. Phone/Fax

Practice location:
  • Phone: 415-664-5018
  • Fax: 415-564-2771
Mailing address:
  • Phone: 415-664-5018
  • Fax: 415-564-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1039
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN N GARDI
Title or Position: OWNER DIRECTOR
Credential: PHD DABNM CCCA
Phone: 415-664-5018