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NPI Code Detail

MEDICARE: ADDIE'S AUTISMFITT CLUB

MEDICARE: ADDIE'S AUTISMFITT CLUB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist22918CA

General Provider Information

NPI Number : 1598124612
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADDIE'S AUTISMFITT CLUB
Provider Business Mailing Address
First Line : 7850 MISSION CENTER #100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1322
Country : US
Telephone Number : 619-578-2232
Fax Number :
Provider Business Practice Location Address
First Line : 7850 MISSION CENTER CT STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1323
Country : US
Telephone Number : 619-578-2232
Fax Number :
Authorized Official
Title or Position : BILLING SPECIALIST
Name : NICOLE OLIVAS
Credential :
Telephone Number : 619-786-3301
Provider Enumeration Date : 02/17/2016
Last Update Date : 02/17/2016

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Directions to “ADDIE'S AUTISMFITT CLUB ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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