Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
SAN DIEGO STATE UNIVERSITY - HEALTHY EARLY YEARS CLINIC
Active
Organization
SAN DIEGO STATE UNIVERSITY - HEALTHY EARLY YEARS CLINIC
Active
Parent organization
SAN DIEGO STATE UNIVERSITY
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAN DIEGO STATE UNIVERSITY
Authorized official
AGNES WONG NICKERSON (ASSOCIATE VP OF FINANCIAL OPERATION)
(619) 594-6017
Entity
Organization
Contact information
Practice address
4283 EL CAJON BLVD, SUITE 200, SAN DIEGO, CA 92105
(619) 530-0122
(619) 530-0822
Mailing address
5500 CAMPANILE DR, SAN DIEGO, CA 92182-1518
(619) 594-6017
(619) 594-5917
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
104100000X
Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up