Organization
PRACTICE OF MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL DE JESUS FORTALEZA M.D. (OWNER)
(213) 802-2555
Entity
Organization
Contact information
Practice address
2607 COLORADO BLVD STE 200, EAGLE ROCK, CA 90041-1086
(213) 802-2555
Mailing address
2607 COLORADO BLVD STE 200, EAGLE ROCK, CA 90041-1086
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
02/23/2026
Last updated
03/16/2026
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