Provider Demographics
NPI:1205441888
Name:FITZPATRICK, WILLIAM ANDREW
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANDREW
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 7TH ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-1429
Mailing Address - Country:US
Mailing Address - Phone:256-497-8293
Mailing Address - Fax:
Practice Address - Street 1:216 SEA FLOAT ST BLDG 218
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5132
Practice Address - Country:US
Practice Address - Phone:619-537-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman