Provider Demographics
NPI:1841223344
Name:PICKERING, BRETTEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETTEN
Middle Name:D
Last Name:PICKERING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-502-1135
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:7910 FROST ST.
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2753
Practice Address - Country:US
Practice Address - Phone:858-496-4800
Practice Address - Fax:858-496-4850
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG61063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G610630Medicaid
CAWG61063EMedicare ID - Type Unspecified
CA00G610630Medicaid