Healthcare Provider Details

I. General information

NPI: 1437337680
Provider Name (Legal Business Name): JESSICA ANDERSON M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 4TH AVE SUITE 306
CHULA VISTA CA
91910-4426
US

IV. Provider business mailing address

450 4TH AVE SUITE 306
CHULA VISTA CA
91910-4426
US

V. Phone/Fax

Practice location:
  • Phone: 949-282-1212
  • Fax:
Mailing address:
  • Phone: 949-282-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU2336
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA6018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: