NPIMap

Organization Active NPI

Bastyr University

Doing business as Bastyr University Clinic

  • Naturopath
  • San Diego, CA
National Provider Identifier
1104160043
Registry record updated Nov 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
NaturopathTaxonomy code 175F00000X
License
ND-556 Issued in CA
Legal business name
BASTYR UNIVERSITY
Doing business as
Bastyr University Clinic
Practice address
4106 Sorrento Valley Blvd
San Diego, CA 92121-1407
Phone
(858) 246-9730
Fax
(858) 246-9710
NPI assigned
Nov 15, 2012
Last updated
Nov 15, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
BASTYR UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Moira Pyle Fitzpatrick, PHD, ND
Title
Vice President
Phone
(858) 246-9701

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X PSY11413 CA
Naturopath 175F00000X ND-556 CA Primary

Addresses

Primary practice location

4106 Sorrento Valley Blvd
San Diego, CA 92121-1407

Mailing address

4106 Sorrento Valley Blvd
San Diego, CA 92121-1407
Phone (858) 246-9730

Other names 1

  • Bastyr University Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bastyr University2 organizations share this tax ID, including this one
Part of
Bastyr University

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4106 Sorrento Valley Blvd
San Diego, CA 92121
Phone (858) 246-9700

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1104160043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 SORRENTO VALLEY BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211407",
            "telephone_number": "858-246-9730",
            "fax_number": "858-246-9710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 SORRENTO VALLEY BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211407",
            "telephone_number": "858-246-9730",
            "fax_number": "858-246-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASTYR UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BASTYR UNIVERSITY",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "FITZPATRICK",
        "authorized_official_first_name": "MOIRA",
        "authorized_official_middle_name": "PYLE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "858-246-9701",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHD, ND"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY11413",
            "primary": false
        },
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": "CA",
            "license": "ND-556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bastyr University Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.