Provider Demographics
NPI:1043753593
Name:FITZGERALD, MICHAEL (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3235
Mailing Address - Country:US
Mailing Address - Phone:510-549-9905
Mailing Address - Fax:
Practice Address - Street 1:2121 WEST ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1927
Practice Address - Country:US
Practice Address - Phone:510-549-9905
Practice Address - Fax:844-270-2102
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8691171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist