Provider Demographics
NPI:1689640658
Name:FITZPATRICK, JILL ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SIERRA COLLEGE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5763
Mailing Address - Country:US
Mailing Address - Phone:530-477-4480
Mailing Address - Fax:530-477-7755
Practice Address - Street 1:280 SIERRA COLLEGE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-477-4480
Practice Address - Fax:530-477-7755
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A635230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A635230Medicaid
G67366Medicare UPIN
CA00A635230Medicare ID - Type Unspecified