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General NPI Number Information
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NPI Number | 1952934093
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Entity Type | Individual
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Provider Name | JOHN EDWARD FREDETTE LMFT
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Gender | Male
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 550 W VISTA WAY STE 406
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City | VISTA
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State | CA
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Zip | 92083-5714
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Country | US
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Telephone | 760-385-8048
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Fax |
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Provider Business Mailing Address
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Address Line | 438 ORANGE GROVE AVE
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City | VISTA
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State | CA
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Zip | 92084-6218
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Country | US
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Telephone | 760-716-1867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT117021
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License Number State | CA
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