Healthcare Provider Details

I. General information

NPI: 1407438120
Provider Name (Legal Business Name): JEREMY HUNTER FITZGERALD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 128
CHINO CA
91708-0128
US

IV. Provider business mailing address

2620 HIGHRIDGE DR
CHINO HILLS CA
91709-4876
US

V. Phone/Fax

Practice location:
  • Phone: 909-597-1821
  • Fax:
Mailing address:
  • Phone: 940-453-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: