Healthcare Provider Details

I. General information

NPI: 1386508836
Provider Name (Legal Business Name): BRETT BOHSTEDT MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ALAMEDA BLVD
SAN DIEGO CA
92118
US

IV. Provider business mailing address

3690 ALEXIA PL
SAN DIEGO CA
92116-2235
US

V. Phone/Fax

Practice location:
  • Phone: 224-612-3672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW-23315
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: