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1841136314 NPI number — SAN DIEGO STATE UNIVERSITY CENTER FOR AUTISM AND DEVELOPMENTAL DISORDERS

NPI Number: 1841136314
Health Care Provider/Practitioner: SAN DIEGO STATE UNIVERSITY CENTER FOR AUTISM AND DEVELOPMENTAL DISORDERS

Information about “1841136314” NPI (SAN DIEGO STATE UNIVERSITY CENTER FOR AUTISM AND DEVELOPMENTAL DISORDERS) exists in 1841136314 in HTML format HTML  |  1841136314 in plain Text format TXT  |  1841136314 in PDF (Portable Document Format) PDF  |  1841136314 in an XML format XML  formats.

NPI Number : 1841136314 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841136314",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "SAN DIEGO STATE UNIVERSITY FOUNDATION",
    "ParentOrgTIN": null,
    "OrgName": "SAN DIEGO STATE UNIVERSITY CENTER FOR AUTISM AND DEVELOPMENTAL DISORDERS",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6363 ALVARADO CT STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92120",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6363 ALVARADO CT STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN DIEGO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92120",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "619-594-2603",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/27/2026",
    "LastUpdateDate": "04/27/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FISHMAN",
    "AuthorizedOfficialFirstName": "INNA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHD",
    "AuthorizedOfficialTelephoneNumber": "619-594-2299",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103G00000X",
        "TaxonomyName": "Clinical Neuropsychologist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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