MEDICARE: FIONA BAERVELDT WERTHEIMER D.O.

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	208000000X	Pediatrics Physician	20A10827	CA
2	208000000X	Pediatrics Physician	OS10427	FL
3	2080N0001X	Neonatal-Perinatal Medicine Physician	2OA10827	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174672885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIONA BAERVELDT WERTHEIMER D.O.

Provider Business Mailing Address
First Line	:	2020 ZONAL AVE
Second Line	:	IRD 820
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1019
Country	:	US
Telephone Number	:	323-226-3406
Fax Number	:	323-226-3440

Provider Business Practice Location Address
First Line	:	2020 ZONAL AVE
Second Line	:	IRD 820
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1019
Country	:	US
Telephone Number	:	323-226-3406
Fax Number	:	323-226-3440

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	06/28/2024

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