MEDICARE: BRETT BOHSTEDT MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LCSW-23315	AZ

General Provider Information

NPI Number	:	1386508836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT BOHSTEDT MSW

Provider Business Mailing Address
First Line	:	3690 ALEXIA PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-2235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 ALAMEDA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92118
Country	:	US
Telephone Number	:	224-612-3672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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