=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356139869
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY JESSUP FISHER MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2025
-----------------------------------------------------
Last Update Date | 04/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 E COLORADO BLVD STE 180
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-6144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-430-6021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1084 N EL CAMINO REAL STE B92024
-----------------------------------------------------
City | ENCINITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92024-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-430-6021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 153891
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------