Provider Demographics
NPI:1700930393
Name:ITO, NOBUKO M (AUD)
Entity type:Individual
Prefix:DR
First Name:NOBUKO
Middle Name:M
Last Name:ITO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 SARATOGA AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1326
Mailing Address - Country:US
Mailing Address - Phone:408-891-1476
Mailing Address - Fax:
Practice Address - Street 1:467 SARATOGA AVE STE 170
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-1326
Practice Address - Country:US
Practice Address - Phone:408-891-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1661231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0016611Medicaid
CAAU0016610Medicaid
CAZZZ20975ZMedicare ID - Type Unspecified
CAAU0016611Medicaid