NPIMap

Organization Active NPI

Neurodynamics Inc

  • Clinical Neurophysiology Physician
  • San Diego, CA
National Provider Identifier
1407932312
Registry record updated Jun 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
Legal business name
NEURODYNAMICS INC
Practice address
2815 Camino del Rio S
Ste 220
San Diego, CA 92108-3815
Phone
(858) 279-6772
Fax
(858) 279-7505
NPI assigned
Oct 31, 2006
Last updated
Jun 30, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
NEURODYNAMICS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 30, 2016

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

Authorized official

Name
Dr. Carolyn Bower, AUDNPI 1255599221
Title
Ceo
Phone
(858) 279-6772

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neurophysiology Physician 2084N0600X Primary
Audiologist 231H00000X

Addresses

Primary practice location

2815 Camino del Rio S
Ste 220
San Diego, CA 92108-3815

Mailing address

2815 Camino del Rio S
Ste 220
San Diego, CA 92108-3815
Phone (858) 279-6772

Other identifiers 1

IdentifierTypeStateIssuer
GAU000820MedicaidCA

Other names 1

  • Neurodynamics, LLC Former legal business name

National Provider Directory

National Provider Directory
Part of
Neurodynamics Inc

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467244800000",
    "number": "1407932312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2815 CAMINO DEL RIO S",
            "address_2": "STE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083815",
            "telephone_number": "858-279-6772",
            "fax_number": "858-279-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2815 CAMINO DEL RIO S",
            "address_2": "STE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083815",
            "telephone_number": "858-279-6772",
            "fax_number": "858-279-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURODYNAMICS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEURODYNAMICS INC",
        "enumeration_date": "2006-10-31",
        "last_updated": "2016-06-30",
        "status": "A",
        "authorized_official_last_name": "BOWER",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-279-6772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "AUD"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GAU000820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neurodynamics, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Jun 30, 2016; 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.