Healthcare Provider Details

I. General information

NPI: 1750161618
Provider Name (Legal Business Name): FLETCHER AND ASSOCIATES PSYCHIATRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 OBERLIN DR STE 301
SAN DIEGO CA
92121-4717
US

IV. Provider business mailing address

PO BOX 26517
SAN DIEGO CA
92196-0517
US

V. Phone/Fax

Practice location:
  • Phone: 858-239-2277
  • Fax: 415-536-2977
Mailing address:
  • Phone: 858-239-2277
  • Fax: 415-536-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT F FLETCHER
Title or Position: OWNER
Credential: MD
Phone: 858-239-2277