Active NPI
Jessica Fazzary
- Acupuncturist
- San Diego, CA
National Provider Identifier
1003397514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC17190
- Practice address
- 2537 University Ave
San Diego, CA 92104-2807 - Phone
- (619) 358-9508
- NPI assigned
- Aug 22, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC17190 | CA | Primary |
Addresses
Primary practice location
2537 University Ave
San Diego, CA 92104-2807
Mailing address
2507 J Ave
National City, CA 91950-7520
Phone (607) 742-6999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC17190 | CA | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David W McKinnon Sustain Acupuncture | Acupuncturist | Past | Accepting new patients |
| Sustain Community Acupuncture | Acupuncturist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Acupuncturist
- San Diego, CA
- NPI 1356903264
-
- Acupuncturist
- San Diego, CA
- NPI 1104124577
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534896000000",
"number": "1003397514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2507 J AVE",
"city": "NATIONAL CITY",
"state": "CA",
"postal_code": "919507520",
"telephone_number": "607-742-6999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2537 UNIVERSITY AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921042807",
"telephone_number": "619-358-9508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZZARY",
"first_name": "JESSICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-22",
"last_updated": "2018-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC17190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.