Organization Active NPI

Rebecca Fitzgerald M.D. , Inc.

  • Procedural Dermatology Physician
  • Los Angeles, CA
National Provider Identifier
1083954226
Registry record updated Feb 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
A49000 Issued in CA
Legal business name
REBECCA FITZGERALD M.D. , INC.
Practice address
321 N Larchmont Blvd
Suite 906
Los Angeles, CA 90004-3025
Phone
(323) 464-8046
NPI assigned
Feb 25, 2013
Last updated
Feb 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rebecca Louis Fitzgerald, M.D.NPI 1285690321
Title
President / Ceo
Phone
(323) 464-8046

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology Physician 207NS0135X A49000 CA Primary

Addresses

Primary practice location

321 N Larchmont Blvd
Suite 906
Los Angeles, CA 90004-3025

Mailing address

321 N Larchmont Blvd
Suite 906
Los Angeles, CA 90004-3025
Phone (323) 464-8046

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131219000800 CA Part B Supplier - Clinic/Group Practice 3072740067 Receives reassigned benefits from 4 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

321 N Larchmont Blvd
Ste 9
Los Angeles, CA 90004
Phone (323) 464-8046

321 N Larchmont Blvd
Ste 906
Los Angeles, CA 90004
Phone (323) 464-8046

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361750400000",
    "number": "1083954226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 N LARCHMONT BLVD",
            "address_2": "SUITE 906",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900043025",
            "telephone_number": "323-464-8046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 N LARCHMONT BLVD",
            "address_2": "SUITE 906",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900043025",
            "telephone_number": "323-464-8046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBECCA FITZGERALD M.D. , INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-25",
        "last_updated": "2013-02-25",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "323-464-8046",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A49000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.