MEDICARE: PAMELA TERESA FITZGERALD MS, RDN

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	133V00000X	Registered Dietitian	974491

General Provider Information

NPI Number	:	1487890869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA TERESA FITZGERALD MS, RDN

Provider Business Mailing Address
First Line	:	1942 FOX HILLS DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5104
Country	:	US
Telephone Number	:	206-240-1232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1942 FOX HILLS DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5104
Country	:	US
Telephone Number	:	310-571-5889
Fax Number	:

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

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	06/25/2019

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