Healthcare Provider Details

I. General information

NPI: 1922770635
Provider Name (Legal Business Name): JASON DUDA AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 CAMPANILE DR SAN DIEGO CA 92182
SAN DIEGO CA
92182-0001
US

IV. Provider business mailing address

4025 OAKCREST DR APT 6
SAN DIEGO CA
92105-2172
US

V. Phone/Fax

Practice location:
  • Phone: 619-594-7747
  • Fax:
Mailing address:
  • Phone: 714-383-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: