Healthcare Provider Details

I. General information

NPI: 1154832004
Provider Name (Legal Business Name): EDINA ATANOS AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 RIDDER PARK DR
SAN JOSE CA
95131-2304
US

IV. Provider business mailing address

1290 RIDDER PARK DR
SAN JOSE CA
95131-2304
US

V. Phone/Fax

Practice location:
  • Phone: 408-392-3840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: