Healthcare Provider Details

I. General information

NPI: 1881224087
Provider Name (Legal Business Name): MALLERY SALEEM EPPLER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 VISTA WAY
OCEANSIDE CA
92054-5661
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-704-5740
  • Fax:
Mailing address:
  • Phone: 760-704-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3422
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: