MEDICARE: DR. CAMERON FATEMI PT, DPT

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	225100000X	Physical Therapist	305960	CA

General Provider Information

NPI Number	:	1174476899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMERON FATEMI PT, DPT

Provider Business Mailing Address
First Line	:	6148 BARONS WAY
Second Line	:
City	:	OAK PARK
State	:	CA
Zip	:	91377-5850
Country	:	US
Telephone Number	:	818-943-7087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 SANTA MONICA BLVD STE 401
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2023
Country	:	US
Telephone Number	:	310-829-8724
Fax Number	:

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

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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