Healthcare Provider Details

I. General information

NPI: 1306458062
Provider Name (Legal Business Name): MR. ASA A MAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 HEALTH CENTER DR
SAN DIEGO CA
92123-2762
US

IV. Provider business mailing address

2929 HEALTH CENTER DR
SAN DIEGO CA
92123-2762
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2600
  • Fax:
Mailing address:
  • Phone: 858-499-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10551
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10896
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: