Individual
MITCHELL FENNERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 SAN PABLO ST, LOS ANGELES, CA 90033-5313
(800) 872-2273
Mailing address
1500 SAN PABLO ST, LOS ANGELES, CA 90033-5313
(317) 345-1039
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
9123
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2022
Last updated
08/30/2022
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