Active NPI
Glenn E Fortini, M.D.
- Neurology Physician
- Davis, CA
National Provider Identifier
1205966041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- A19839
- Practice address
- 1 Shields Ave
Davis, CA 95616-5270 - Phone
- (530) 752-2300
- Fax
- (530) 752-2306
- NPI assigned
- Mar 7, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | A19839 | CA | Primary |
Addresses
Primary practice location
1 Shields Ave
Davis, CA 95616-5270
Mailing address
417 Mace Blvd.,
Suite J, #341
Davis, CA 95618
Phone (530) 756-5539
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A19839 | CA | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205966041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "417 MACE BLVD.,",
"address_2": "SUITE J, #341",
"city": "DAVIS",
"state": "CA",
"postal_code": "95618",
"telephone_number": "530-756-5539",
"fax_number": "530-756-2022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 SHIELDS AVE",
"city": "DAVIS",
"state": "CA",
"postal_code": "956165270",
"telephone_number": "530-752-2300",
"fax_number": "530-752-2306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTINI",
"first_name": "GLENN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "CA",
"license": "A19839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.