T J Fitzgibbons MD Inc

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

G32025 Issued in CA

Legal business name

T J FITZGIBBONS MD INC

Doing business as

Fitzgibbons Vein Center

Practice address

1245 Wilshire Blvd
Suite 905
Los Angeles, CA 90017-4810

Phone

(213) 977-1211

Fax

(213) 977-0625

NPI assigned

Dec 10, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Terrence J Fitzgibbons, M.D.NPI 1285740464

Title

Medical Director

Phone

(213) 977-1211

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fitzgibbons Vein Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Fitzgibbons Vein Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• T J Fitzgibbons MD Inc

  • Vascular Surgery Physician
  • Los Angeles, CA
  • NPI 1831335363
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Terrence John Fitzgibbons, M.D.

  • Vascular Surgery Physician
  • Los Angeles, CA
  • NPI 1285740464
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1291939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1861795965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 WILSHIRE BLVD",
            "address_2": "SUITE 905",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174810",
            "telephone_number": "213-977-1211",
            "fax_number": "213-977-0625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 WILSHIRE BLVD",
            "address_2": "SUITE 905",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900174810",
            "telephone_number": "213-977-1211",
            "fax_number": "213-977-0625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "T J FITZGIBBONS MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-10",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "FITZGIBBONS",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "213-977-1211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "G32025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF CA LICENSE",
            "identifier": "G32025",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fitzgibbons Vein Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Vascular Surgery Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Vascular Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.