Healthcare Provider Details

I. General information

NPI: 1164493656
Provider Name (Legal Business Name): ROBERT JOHN OLSSON AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34520 BOB WILSON DR ENT DEPT -- BLDG 2, 2ND FLOOR
SAN DIEGO CA
92134-2098
US

IV. Provider business mailing address

5025 LAUREL ST
SAN DIEGO CA
92105-5313
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8164
  • Fax: 619-532-7243
Mailing address:
  • Phone: 619-892-3500
  • Fax: 619-342-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU787
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA1615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: