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General NPI Number Information
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NPI Number | 1366189177
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Entity Type | Individual
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Provider Name | TARA-ANN JOY WALLER AU.D.
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Gender | Female
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Dates
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Enumeration Date | 05/13/2022
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 5855 SILVER CREEK VALLEY RD
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City | SAN JOSE
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State | CA
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Zip | 95138-1059
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Country | US
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Telephone | 408-574-9219
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Fax |
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Provider Business Mailing Address
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Address Line | 808 W SAN CARLOS ST UNIT 491
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City | SAN JOSE
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State | CA
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Zip | 95126-4360
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Country | US
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Telephone | 407-721-2064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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