Healthcare Provider Details

I. General information

NPI: 1700930393
Provider Name (Legal Business Name): NOBUKO M ITO AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 SARATOGA AVE STE 170
SAN JOSE CA
95129-1326
US

IV. Provider business mailing address

467 SARATOGA AVE STE 170
SAN JOSE CA
95129-1326
US

V. Phone/Fax

Practice location:
  • Phone: 408-891-1476
  • Fax:
Mailing address:
  • Phone: 408-891-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1661
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAU1661
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberAU1661
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU1661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: