=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619193273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW BRUCE FISHER PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5665 COLLEGE AVE SUITE 340A
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94618-1625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-547-6223
-----------------------------------------------------
Fax | 510-420-0888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 237 PARK VIEW AVE
-----------------------------------------------------
City | PIEDMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94610-1041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-658-5363
-----------------------------------------------------
Fax | 510-658-5398
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TP0016X
-----------------------------------------------------
Taxonomy Name | Prescribing (Medical) Psychologist
-----------------------------------------------------
License Number | PSY9638
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------