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General NPI Number Information
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NPI Number | 1528122025
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Entity Type | Individual
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Provider Name | GARY RANDALL FUJIMOTO M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 20 FARM RD.
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City | LOS ALTOS
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State | CA
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Zip | 94024-7020
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Country | US
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Telephone | 650-619-6011
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Fax | 650-964-8925
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Provider Business Mailing Address
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Address Line | P.O. BOX 3583
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City | LOS ALTOS
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State | CA
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Zip | 94024-7020
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Country | US
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Telephone | 650-619-6011
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Fax | 650-964-8925
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | G43075
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | G43075
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License Number State | CA
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