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NPI Code Detail

MEDICARE: WILLIAM FENERTY

MEDICARE: WILLIAM FENERTY
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
1207Q00000XFamily Medicine Physician20A4089CA

General Provider Information

NPI Number : 1184625915
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM FENERTY
Provider Business Mailing Address
First Line : 279 IMPERIAL HWY
Second Line : SUITE 730
City : FULLERTON
State : CA
Zip : 92835-1041
Country : US
Telephone Number : 714-449-4842
Fax Number : 714-449-4816
Provider Business Practice Location Address
First Line : 1514 VALLEY VISTA DR
Second Line :
City : DIAMOND BAR
State : CA
Zip : 91765-3929
Country : US
Telephone Number : 714-449-4842
Fax Number : 714-449-4816
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 11/23/2009

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