=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144659152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOS GATOS COMMUNITY AUDIOLOGY AND HEARING AID CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2013
-----------------------------------------------------
Last Update Date | 08/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15899 LOS GATOS ALMADEN RD STE 8
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-3739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-354-1312
-----------------------------------------------------
Fax | 408-354-2118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15899 LOS GATOS ALMADEN RD STE 8
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-3739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-354-1312
-----------------------------------------------------
Fax | 408-354-2118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST
-----------------------------------------------------
Name | CHRISTINE THROM
-----------------------------------------------------
Credential | AU.D.
-----------------------------------------------------
Telephone | 408-354-1312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AU1862
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------