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DR. PEOLIA KANSAS FONSWORTH M.D. M.B.A NPI 1639412091


NPI Information

NPI: 1639412091
Provider Name: DR. PEOLIA KANSAS FONSWORTH, M.D., M.B.A
Classification: Specialist - 174400000X
Entity Type: Individual
Organization: MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP

PECOS Registration: Yes

Address:
1000 W CARSON ST
TORRANCE, CA
ZIP 90502
Phone: (310) 222-2345
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DR. Peolia Kansas Fonsworth, M.D., M.B.A is a specialist in Torrance, CA with 11 years of experience. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DR. Peolia Kansas Fonsworth, M.D., M.B.A NPI is 1639412091. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF CALIFORNIA, IRVINE, CALIFORNIA COLLEGE OF MEDICINE
Graduation Year:2013

The provider's business location address is:

1000 W CARSON ST
TORRANCE, CA
ZIP 90502-004
Phone: (310) 222-2345

The NPI 1639412091 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/3/2013 and was last updated on 3/15/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1390200000XStudent in an Organized Health Care Education/Training ProgramNo
2174400000XSpecialistA132680CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.