Healthcare Provider Details

I. General information

NPI: 1194791533
Provider Name (Legal Business Name): BRENT FARRELL FLETCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRENT FARRELL FLETCHER M.D.

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 STEVENS AVE STE 206
SOLANA BEACH CA
92075-2065
US

IV. Provider business mailing address

462 STEVENS AVE STE 206
SOLANA BEACH CA
92075-2065
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 TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA96149
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA96149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: