# T J FITZGIBBONS MD INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fitzgibbons Vein Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861795965
- **Authorized official:** DR. TERRENCE J FITZGIBBONS M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (213) 977-1211

## Contact information

- **Practice address:** 1245 WILSHIRE BLVD, SUITE 905, LOS ANGELES, CA 90017-4810
- **Practice address phone:** (213) 977-1211
- **Practice address fax:** (213) 977-0625
- **Mailing address:** 1245 WILSHIRE BLVD, SUITE 905, LOS ANGELES, CA 90017-4810
- **Mailing address phone:** (213) 977-1211
- **Mailing address fax:** (213) 977-0625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | G32025 | CA | Yes |

## Other

- **Enumeration date:** 12/10/2010
- **Last updated:** 07/29/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | G32025 | STATE OF CA LICENSE | CA |