Healthcare Provider Details

I. General information

NPI: 1891552584
Provider Name (Legal Business Name): JOSE AUDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 BERNAL RD # B
SAN JOSE CA
95119-1809
US

IV. Provider business mailing address

298 B BERNAL ROAD
SAN JOSE CA
95119
US

V. Phone/Fax

Practice location:
  • Phone: 408-343-9089
  • Fax:
Mailing address:
  • Phone: 408-343-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: