MEDICARE: DR. ROBERT EDWARD OBRECHT PH.D., ABPP-CL

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	103G00000X	Clinical Neuropsychologist	6301008121	MI

General Provider Information

NPI Number	:	1427029933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EDWARD OBRECHT PH.D., ABPP-CL

Provider Business Mailing Address
First Line	:	776 F AVE
Second Line	:
City	:	CORONADO
State	:	CA
Zip	:	92118-2130
Country	:	US
Telephone Number	:	619-435-3696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 RENDOVA RD
Second Line	:	BUILDING 156
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5401
Country	:	US
Telephone Number	:	619-437-5612
Fax Number	:

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/08/2007

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