Provider Demographics
NPI:1598754939
Name:FISHER, BENA (MD)
Entity Type:Individual
Prefix:DR
First Name:BENA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:360 H ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5511
Mailing Address - Country:US
Mailing Address - Phone:619-585-7227
Mailing Address - Fax:619-585-3190
Practice Address - Street 1:360 H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5511
Practice Address - Country:US
Practice Address - Phone:619-585-7227
Practice Address - Fax:619-585-3190
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG505322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A51715Medicare UPIN