Healthcare Provider Details

I. General information

NPI: 1508580705
Provider Name (Legal Business Name): FORTUNA FAMILY MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 NEWBURG RD
FORTUNA CA
95540-2818
US

IV. Provider business mailing address

2404 NEWBURG RD
FORTUNA CA
95540-2818
US

V. Phone/Fax

Practice location:
  • Phone: 707-617-2002
  • Fax: 833-941-4882
Mailing address:
  • Phone: 707-617-2002
  • Fax: 833-941-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATHAN DARIO BRINCKHAUS
Title or Position: MD
Credential:
Phone: 707-617-2002