Provider Demographics
NPI:1023776200
Name:NESBITT AUDIOLOGY, INC
Entity type:Organization
Organization Name:NESBITT AUDIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:NESBITT
Authorized Official - Suffix:
Authorized Official - Credentials:FAA
Authorized Official - Phone:760-452-2140
Mailing Address - Street 1:4407 MANCHESTER AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4941
Mailing Address - Country:US
Mailing Address - Phone:760-452-2140
Mailing Address - Fax:760-452-2142
Practice Address - Street 1:4407 MANCHESTER AVE STE 108
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4941
Practice Address - Country:US
Practice Address - Phone:760-452-2140
Practice Address - Fax:760-452-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB015564-10-2021OtherCORPORATE BUSINESS LICENSE