Active NPI
William Fenerty
- Family Medicine Physician
- Diamond Bar, CA
National Provider Identifier
1184625915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A4089
- Practice address
- 1514 Valley Vista Dr
Diamond Bar, CA 91765-3929 - Phone
- (714) 449-4842
- Fax
- (714) 449-4816
- NPI assigned
- Aug 2, 2005
- Last updated
- Nov 23, 2009
- Sex
- Male
- Sole proprietor
- No
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 | 20A4089 | CA | Primary |
Addresses
Primary practice location
1514 Valley Vista Dr
Diamond Bar, CA 91765-3929
Mailing address
279 Imperial Hwy
Suite 730
Fullerton, CA 92835-1041
Phone (714) 449-4842
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A4089 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258934400000",
"number": "1184625915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "279 IMPERIAL HWY",
"address_2": "SUITE 730",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928351041",
"telephone_number": "714-449-4842",
"fax_number": "714-449-4816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1514 VALLEY VISTA DR",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917653929",
"telephone_number": "714-449-4842",
"fax_number": "714-449-4816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENERTY",
"first_name": "WILLIAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-02",
"last_updated": "2009-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A4089",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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- Nicole Dominguez Fidel
- May Fong-Chang, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.