Provider Demographics
NPI:1326522566
Name:FORTRA MEDICAL GROUP OF CALIFORNIA, PC
Entity Type:Organization
Organization Name:FORTRA MEDICAL GROUP OF CALIFORNIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:650-466-6364
Mailing Address - Street 1:570 PRICE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1433
Mailing Address - Country:US
Mailing Address - Phone:650-466-6364
Mailing Address - Fax:
Practice Address - Street 1:570 PRICE AVE STE 400
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1433
Practice Address - Country:US
Practice Address - Phone:650-466-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty