Active NPI
Robert Todd Fassett, M.D.
- Family Medicine Physician
- San Diego, CA
National Provider Identifier
1780827121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G77451
- Practice address
- 12230 El Camino Real
Fourth Floor
San Diego, CA 92130-2090 - Phone
- (619) 840-6287
- NPI assigned
- Apr 15, 2009
- 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 | G77451 | CA | Primary |
Addresses
Primary practice location
12230 El Camino Real
Fourth Floor
San Diego, CA 92130-2090
Mailing address
12230 El Camino Real
Fourth Floor
San Diego, CA 92130-2090
Phone (619) 840-6287
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 |
|---|---|---|---|
| G77451 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239753600000",
"number": "1780827121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12230 EL CAMINO REAL",
"address_2": "FOURTH FLOOR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302090",
"telephone_number": "619-840-6287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12230 EL CAMINO REAL",
"address_2": "FOURTH FLOOR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302090",
"telephone_number": "619-840-6287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FASSETT",
"first_name": "ROBERT",
"middle_name": "TODD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-04-15",
"last_updated": "2009-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G77451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.