Healthcare Provider Details

I. General information

NPI: 1851577605
Provider Name (Legal Business Name): JEFFREY PETER FIORENZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UPPER RAGSDALE DRIVE SUITE 200
MONTEREY CA
93940-7849
US

IV. Provider business mailing address

23 UPPER RAGSDALE DRIVE SUITE 200
MONTEREY CA
93940-7849
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-3577
  • Fax: 831-375-1478
Mailing address:
  • Phone: 831-375-3577
  • Fax: 831-375-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number247495
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA140177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: