Provider Demographics
NPI:1457642803
Name:FERTIG, PATRICIA A (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:FERTIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN DIEGO FAMILY CARE DBA MID-CITY COMMUNITY CLINIC
Mailing Address - Street 2:4290 POLK AVENUE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1524
Mailing Address - Country:US
Mailing Address - Phone:619-563-0250
Mailing Address - Fax:858-633-4681
Practice Address - Street 1:19531 MCLANE ST
Practice Address - Street 2:STE B
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:951-358-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A149282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program