Organization
T J FITZGIBBONS MD INC
Active
Other names
Fitzgibbons Vein Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRENCE J FITZGIBBONS M.D. (MEDICAL DIRECTOR)
(213) 977-1211
Entity
Organization
Contact information
Practice address
1245 WILSHIRE BLVD, SUITE 905, LOS ANGELES, CA 90017-4810
(213) 977-1211
(213) 977-0625
Mailing address
1245 WILSHIRE BLVD, SUITE 905, LOS ANGELES, CA 90017-4810
(213) 977-1211
(213) 977-0625
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
G32025
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G32025
STATE OF CA LICENSE
CA
Enumeration date
12/10/2010
Last updated
07/29/2014
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