Blaise Fortunata (NPI# 1609816636, PAC ID# 6002826351) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CLINICAL PSYCHOLOGIST.
| Nation Provider ID (NPI) | 1609816636 |
| PAC ID by PECOS | 6002826351 |
| Professional Enrollment ID | I20160210002223 |
| Full Name | Blaise Fortunata |
| Organization Legal Name | PERMANENTE MEDICAL GROUP INC |
| Address |
800 Sereno Dr Vallejo CA 94589-2411 |
| Phone Number | 7076514295 |
| Gender | F |
| Credential | CP |
| Graduation Year | 1998 |
| Primary Specialty | CLINICAL PSYCHOLOGIST |
| Group Practice PAC ID | 8921910225 |
| Number of Group Practice Members | 6894 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 800 Sereno Dr, Vallejo, CA 94589-2411 | 7076514295 | PERMANENTE MEDICAL GROUP INC |
| Organization Legal Name | PERMANENTE MEDICAL GROUP INC |
| Physicians | 9623 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Richard Kailean Mchugh | Otolaryngology | Permanente Medical Group Inc | 7300 Wyndham Dr, Sacramento, CA 95823-4913 |
| Catherine J. Choi | Ophthalmology | Permanente Medical Group Inc | 320 Lennon Ln, Walnut Creek, CA 94598-2419 |
| Justin M Leazenby | Psychologist, Clinical | Permanente Medical Group Inc | 800 Sereno Dr, Vallejo, CA 94589-2411 |
| Crissy A Bankston | Psychologist, Clinical | Permanente Medical Group Inc | 3454 Hillcrest Ave, Antioch, CA 94531-8238 |
| Frank W Lien | Family Medicine | Permanente Medical Group Inc | 1190 Veterans Blvd, Redwood City, CA 94063-2037 |
| Mona Collado Ferrer-kaw | Psychiatry | Permanente Medical Group Inc | 111 Smith Ranch Rd, San Rafael, CA 94903-1939 |
| Matthew J Holland | Psychologist, Clinical | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Shawn M Youngs | Family Medicine | Permanente Medical Group Inc | 10305 Promenade Pkwy, Elk Grove, CA 95757-9400 |
| Kristin G Leach | Family Medicine | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Valerie M Tiscareno | Qualified Audiologist | Permanente Medical Group Inc | 15 Southgate Ave, Daly City, CA 94015-1413 |
| Street Address |
800 SERENO DR |
| City | VALLEJO |
| State | CA |
| Zip | 94589-2411 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Justin M Leazenby | Psychologist, Clinical | Permanente Medical Group Inc | 800 Sereno Dr, Vallejo, CA 94589-2411 |
| Lynn Mckenna | Clinical Social Worker | Permanente Medical Group Inc | 800 Sereno Dr, Vallejo, CA 94589-2411 |
| Ryan M Berman | Psychologist, Clinical | Permanente Medical Group Inc | 800 Sereno Dr, Vallejo, CA 94589-2411 |
| Margaret M Lagomarsino | Nurse Practitioner | Permanente Medical Group Inc | 800 Sereno Dr, Vallejo, CA 94589-2411 |
| Nicholas Reeves | Psychiatry | Permanente Medical Group Inc | 800 Sereno Dr, Vallejo, CA 94589-2411 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Wayne K Ogata | Optometry | 4300 Sonoma Blvd, Suite 508, Vallejo, CA 94589-2210 | |
| Matthew J Holland | Psychologist, Clinical | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Jamie S Baskett | Clinical Social Worker | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Jonathan D Getz | Psychiatry | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Serena M Wong | Psychiatry | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Heather L Nelson | Psychologist, Clinical | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Jeremiah L Johnson | Psychologist, Clinical | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Jeannie E Celestial | Psychologist, Clinical | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Angel A Hurtado | Clinical Social Worker | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Allen T Mckee | Psychiatry | Permanente Medical Group Inc | 1761 Broadway St, Vallejo, CA 94589-2226 |
| Find all physicians in zip 94589 | |||
| City | VALLEJO |
| Zip Code | 94589 |
| Specialty | CLINICAL PSYCHOLOGIST |
| City + Specialty | VALLEJO + CLINICAL PSYCHOLOGIST |
Please comment or provide details below to improve the information on Blaise Fortunata.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.