Provider Demographics
NPI:1518532340
Name:FISHELL, RICHARD ALAN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:FISHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5470 BALTIMORE DR UNIT 21
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2070
Mailing Address - Country:US
Mailing Address - Phone:949-233-3809
Mailing Address - Fax:
Practice Address - Street 1:3400 TARAWA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5002
Practice Address - Country:US
Practice Address - Phone:619-537-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist