Healthcare Provider Details

I. General information

NPI: 1922998178
Provider Name (Legal Business Name): KADIE MARIE FISCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 GATEWAY CENTER WAY STE 300
SAN DIEGO CA
92102-4550
US

IV. Provider business mailing address

6459 REFLECTION DR APT 110
SAN DIEGO CA
92124-3125
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-2156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: