California Polytechnic State University

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Legal business name

CALIFORNIA POLYTECHNIC STATE UNIVERSITY

Practice address

1 Grand Ave
San Luis Obispo, CA 93407-9000

Phone

(805) 756-5491

NPI assigned

Mar 19, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. James Matthew Eggen, ATC

Title

Assistant Athletic Trainer

Phone

(805) 756-5491

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558485896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13020 ATASCADERO RD",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934225902",
            "telephone_number": "805-458-5193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GRAND AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934079000",
            "telephone_number": "805-756-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA POLYTECHNIC STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EGGEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "ASSISTANT ATHLETIC TRAINER",
        "authorized_official_telephone_number": "805-756-5491",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• California Department of Corrections and Rehabilitation
• California Dermatology Institute PC
• California Medical Surgery Center LLC
• California Men's Colony Hospital
• California Neurohealth
• California Polytechnic State University at San Luis Obispo
• California Polytechnic State University at San Luis Obispo
• California Retina Consultants
• California Wellness Center
• Katie Callahan

• Athletic Trainer in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.