Healthcare Provider Details

I. General information

NPI: 1801097688
Provider Name (Legal Business Name): JACQUELINE B. ADLER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 W VISTA WAY STE J
VISTA CA
92083-6030
US

IV. Provider business mailing address

12698 MONTEREY CYPRESS WAY
SAN DIEGO CA
92130-2422
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-8770
  • Fax: 760-726-0644
Mailing address:
  • Phone: 858-775-8496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAU420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: