Healthcare Provider Details

I. General information

NPI: 1164429015
Provider Name (Legal Business Name): ROY MASAMI FUJITANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CITY BLVD W SUITE 700
ORANGE CA
92868-2903
US

IV. Provider business mailing address

333 CITY BLVD W SUITE 700
ORANGE CA
92868-2903
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5453
  • Fax: 714-456-6070
Mailing address:
  • Phone: 714-456-5453
  • Fax: 714-456-6070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG54101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: