Provider Demographics
NPI:1952640856
Name:FITZGERALD, DONNA M (BS, CPHT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:BS, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25915 WESTVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-1941
Mailing Address - Country:US
Mailing Address - Phone:510-434-5821
Mailing Address - Fax:
Practice Address - Street 1:25915 WESTVIEW WAY
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-1941
Practice Address - Country:US
Practice Address - Phone:510-434-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54289302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization