San Diego State University

Primary specialty

Audiologist-Hearing Aid FitterTaxonomy code 237600000X

Legal business name

SAN DIEGO STATE UNIVERSITY

Practice address

5500 Campanile Dr
San Diego, CA 92182-1518

Phone

(619) 594-7747

Fax

(619) 594-5917

NPI assigned

Mar 11, 2016

Organization subpart

Yes

Parent organization

SAN DIEGO STATE UNIVERSITYAs reported in NPPES

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

Authorized official

Name

Agnes Wong Nickerson

Title

Associate VP of Financial Operation

Phone

(619) 594-6017

Specialties & licenses 2

Addresses

Other names 1

• San Diego State University Speech, Language and Hearing Clinic Other name

Part of

San Diego State University

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• San Diego State University

  • Clinical Medical Laboratory
  • San Diego, CA
  • NPI 1649380726
  NPPES parent name

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

{
    "created_epoch": "1457654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457654400000",
    "number": "1972964468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 CAMPANILE DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921821518",
            "telephone_number": "619-594-7747",
            "fax_number": "619-594-5917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 CAMPANILE DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921821518",
            "telephone_number": "619-594-7747",
            "fax_number": "619-594-5917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN DIEGO STATE UNIVERSITY",
        "enumeration_date": "2016-03-11",
        "last_updated": "2016-03-11",
        "status": "A",
        "authorized_official_last_name": "WONG NICKERSON",
        "authorized_official_first_name": "AGNES",
        "authorized_official_title_or_position": "ASSOCIATE VP OF FINANCIAL OPERATION",
        "authorized_official_telephone_number": "619-594-6017"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Diego State University Speech, Language and Hearing Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• San Diego Sports and Minimally Invasive Surgery Center LLC
• San Diego Sports Medicine & Orthopaedic Center
• San Diego Sports Medicine & Orthopaedic Center Inc.
• San Diego Sports Physical Therapy, PC
• San Diego State University
• San Diego State University - Healthy Early Years Clinic
• San Diego State University Center for Autism and Developmental Disorders
• San Diego State University Student Health Services
• San Diego State University Student Health Services
• San Diego Student Recovery

• Audiologist-Hearing Aid Fitter in San Diego, CA
• Providers in San Diego, CA by specialty
• Audiologist-Hearing Aid Fitter in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.