MEDICARE: AIDA FITZGERALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator
3	390200000X	Student in an Organized Health Care Education/Training Program
4	104100000X	Social Worker	ASW112875	CA

General Provider Information

NPI Number	:	1053901769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIDA FITZGERALD

Provider Business Mailing Address
First Line	:	321 SAN FELIPE RD STE 12
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-3035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 SAN FELIPE RD STE 12
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-3035
Country	:	US
Telephone Number	:	669-347-4314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	08/27/2025

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Directions to “ AIDA FITZGERALD ” Practice Location

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