Provider Demographics
NPI:1427029933
Name:OBRECHT, ROBERT EDWARD (PHD, ABPP-CL)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:OBRECHT
Suffix:
Gender:M
Credentials:PHD, ABPP-CL
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:776 F AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2130
Mailing Address - Country:US
Mailing Address - Phone:619-435-3696
Mailing Address - Fax:
Practice Address - Street 1:2424 RENDOVA RD
Practice Address - Street 2:BUILDING 156
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5401
Practice Address - Country:US
Practice Address - Phone:619-437-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008121103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist