Healthcare Provider Details

I. General information

NPI: 1699685248
Provider Name (Legal Business Name): AUDRA MARIE NAGBY MS, MM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 UNIVERSITY AVE
LA MESA CA
91942-0500
US

IV. Provider business mailing address

11778 OAK CREEK DR
LAKESIDE CA
92040-1030
US

V. Phone/Fax

Practice location:
  • Phone: 619-333-0434
  • Fax:
Mailing address:
  • Phone: 619-258-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: