Healthcare Provider Details

I. General information

NPI: 1578891081
Provider Name (Legal Business Name): DAVID JAMES FISHER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 FAIRBURN AVE SUITE 203
LOS ANGELES CA
90025-5958
US

IV. Provider business mailing address

1800 FAIRBURN AVE SUITE 203
LOS ANGELES CA
90025-5958
US

V. Phone/Fax

Practice location:
  • Phone: 310-552-0868
  • Fax:
Mailing address:
  • Phone: 310-552-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberRP-030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: