Active NPI
Edgar Firme Fortin, NP
- Family Medicine Physician
- Glendale, CA
National Provider Identifier
1174339972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 95028352
- Practice address
- 3498 Linda Vista Rd
Glendale, CA 91206-1440 - Phone
- (323) 717-2139
- NPI assigned
- Dec 6, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 95028352 | CA | Primary |
Addresses
Primary practice location
3498 Linda Vista Rd
Glendale, CA 91206-1440
Mailing address
3498 Linda Vista Rd
Glendale, CA 91206-1440
Phone (323) 717-2139
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95028352 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733443200000",
"number": "1174339972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3498 LINDA VISTA RD",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912061440",
"telephone_number": "323-717-2139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3498 LINDA VISTA RD",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912061440",
"telephone_number": "323-717-2139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTIN",
"first_name": "EDGAR",
"middle_name": "FIRME",
"name_prefix": "Mr.",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-06",
"last_updated": "2024-12-06",
"certification_date": "2024-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "95028352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.