Healthcare Provider Details

I. General information

NPI: 1952497265
Provider Name (Legal Business Name): MARNIE L FISCHER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 CAMPUS POINT DR SUITE 100
SAN DIEGO CA
92121-1520
US

IV. Provider business mailing address

10170 SORRENTO VALLEY RD MAIL DROP SV-5
SAN DIEGO CA
92121-1604
US

V. Phone/Fax

Practice location:
  • Phone: 858-678-7050
  • Fax:
Mailing address:
  • Phone: 858-784-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164004126
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number956878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: