Eric Jonathan Fitzmedrud, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY23669 Issued in CA

Practice address

5636 Casino Ave
San Pablo, CA 94806-4232

Phone

(650) 814-7823

NPI assigned

Mar 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1659400141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 MAIN STRRET, #706",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940230706",
            "telephone_number": "650-814-7823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5636 CASINO AVE",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948064232",
            "telephone_number": "650-814-7823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZMEDRUD",
        "first_name": "ERIC",
        "middle_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2021-12-06",
        "certification_date": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY23669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janik Ferreira - Ward
• Victoria Fidel, RAS
• Michael Dennis Fidler, M.D.
• Shanda Fields
• Chuck Fisher, LCSW
• Fatimah Easter Flynt, LVN
• Janeann Fontenot
• Matthew Steven Fore, MD
• Julie Formica
• Robert A Fox, MD

• Clinical Psychologist in San Pablo, CA
• Providers in San Pablo, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.