Healthcare Provider Details

I. General information

NPI: 1841136314
Provider Name (Legal Business Name): SAN DIEGO STATE UNIVERSITY CENTER FOR AUTISM AND DEVELOPMENTAL DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 ALVARADO CT STE 100
SAN DIEGO CA
92120
US

IV. Provider business mailing address

6363 ALVARADO CT STE 100
SAN DIEGO CA
92120
US

V. Phone/Fax

Practice location:
  • Phone: 619-594-2603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. INNA FISHMAN
Title or Position: DIRECTOR
Credential: PHD
Phone: 619-594-2299