Healthcare Provider Details

I. General information

NPI: 1295659480
Provider Name (Legal Business Name): SPECTRUM MENTAL HEALTH NURSING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 E BOBIER DR
VISTA CA
92084-3026
US

IV. Provider business mailing address

1111 6TH AVE STE 550
SAN DIEGO CA
92101-5211
US

V. Phone/Fax

Practice location:
  • Phone: 510-283-8560
  • Fax: 858-216-1902
Mailing address:
  • Phone: 510-283-8560
  • Fax: 858-216-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S FITZGERALD
Title or Position: PMHNP
Credential: PMHNP
Phone: 510-283-8560