Fortuna Family Medical Group Inc
Organization Active NPI Family Medicine Physician · Fortuna, CA
NPI 1376655217 · NPPES record last updated Sep 26, 2007
Key facts
- NPI
- 1376655217
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- FORTUNA FAMILY MEDICAL GROUP INC
- Practice address
- 874 Main St
Fortuna, CA 95540-1926 - Phone
- (707) 725-3334
- Fax
- (707) 725-2455
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. George A Jutila, MD
- Title
- Vice President
- Phone
- (707) 725-3334
Practitioners 3
-
Mary Terese Dodd, FNP
-
Lindsey Mendez, FNP
-
Mark Cross, PA-C
National Provider Directory
Locations
874 Main St
Fortuna, CA 95540
Phone (707) 725-3334
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
874 Main St
Fortuna, CA 95540-1926
Mailing address
874 Main St
Fortuna, CA 95540-1926
Phone (707) 725-3334
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0021870 | Medicaid | CA | |
| RHM03936F | Other | RURAL HEALTH MEDICAL |
Other names
- Olson Goble & Jutila Inc
Other providers in Fortuna, CA
- Ana Fernanda Fierro
- Amber Ford
- Fortuna Assisted Living LLC
- Fortuna Chiropractic LLC
- Fortuna Elementary School District
- Fortuna Family Medicine Inc.
- Fortuna Pharmacy Inc
- Fortuna Rehabilitation & Wellness Center, LP
- Fortuna Union High School
- Tatsiana Franco
All providers in Fortuna, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.