Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Practice of Medicine

Organization Geriatric Medicine (Family Medicine) Physician · NPI 1629922083

Practice of Medicine is a Geriatric Medicine (Family Medicine) Physician in Eagle Rock, California. Registered with an NPI since 2026.

In the registry since
2026

Practice location Address checks out

2607 Colorado Blvd Ste 200
Eagle Rock, CA 90041-1086
Phone: (213) 802-2555
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Family Medicine) Physician (primary) Taxonomy 207QG0300X

Record details

NPI number1629922083
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Paul Fortaleza — Owner · (213) 802-2555
NPI enumeratedFebruary 23, 2026
Last updated in NPPESMarch 16, 2026
Certification dateMarch 16, 2026
Mailing address2607 Colorado Blvd Ste 200, Eagle Rock, CA 90041-1086