Healthcare Provider Details

I. General information

NPI: 1780935940
Provider Name (Legal Business Name): EMILY E. FLETCHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 FENTON ST. SUITE 100
CHULA VISTA CA
91914-3516
US

IV. Provider business mailing address

3860 CALLE FORTUNADA SUITE 200
SAN DIEGO CA
92123-4802
US

V. Phone/Fax

Practice location:
  • Phone: 619-656-3040
  • Fax: 619-656-3045
Mailing address:
  • Phone: 858-636-4300
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA122247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: