Healthcare Provider Details

I. General information

NPI: 1609072875
Provider Name (Legal Business Name): ANDREW DICKMAN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 EL CAMINO REAL SUITE 105
CARLSBAD CA
92008-2194
US

IV. Provider business mailing address

7 BAWLEY ST
LAGUNA NIGUEL CA
92677-4747
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-7800
  • Fax: 760-729-7879
Mailing address:
  • Phone: 949-487-1951
  • Fax: 949-487-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU 316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: