Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G55475 | CA |
N | 208600000X | Surgeon | G55475 | CA |
N | 2086S0129X | Vascular Surgeon | G55475 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G55475 | CA |
NPI | 1134237761 |
---|---|
Provider Name | Fritz J Baumgartner |
First Address | Los Alamitos, CA 90720 |
Second Address | Los Alamitos, CA 90720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 04/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G554750 | (05) | CA |
F08296 | (02) |