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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

PRACTICE OF MEDICINE
NPI 1629922083
Family Medicine - Geriatric Medicine in Eagle Rock, CA

Active since February 23, 2026CLIA 05D2345753 · Waiver
2607 COLORADO BLVD STE 200, EAGLE ROCK, CA 90041(213) 802-2555 Get Directions Write a Review

NPPES record last updated: September 15, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Sep 15, 2026, Mar 16, 2026 (2 updates tracked since 2026).

About Practice Of Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRACTICE OF MEDICINE (NPI 1629922083) is a healthcare organization registered as a geriatric medicine in Eagle Rock, California and active in the NPI registry since February 2026. The organization holds a CLIA Waiver certificate valid through June 16, 2028 and lists Paul De Jesus Fortaleza, Owner, as its authorized official.

NPPES Registry Identity

NPI1629922083
Entity TypeOrganization
Primary Taxonomy207QG0300X
Legal Business NamePRACTICE OF MEDICINE
Location Address2607 COLORADO BLVD STE 200Eagle Rock, CA 90041-1086
Mailing Address2607 Colorado Blvd Ste 200Eagle Rock, CA 90041-1086
Phone(213) 802-2555
Organization SubpartNo
Authorized OfficialPaul De Jesus FortalezaOwner · (213) 802-2555
Enumeration DateFebruary 23, 2026
Last NPPES UpdateSeptember 15, 20262 updates tracked since enumeration
NPPES CertifiedSeptember 15, 2026
✔ NPI 1629922083 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Geriatric MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QG0300X
Definition
A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.
2607 COLORADO BLVD STE 200, Eagle Rock, CA 90041
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2345753

Practice Of Medicine · Eagle Rock, CA
Active · expires Jun 16, 2028
CLIA Number05D2345753
Laboratory TypePhysician Office
Certificate Effective DateJune 17, 2026
Certificate Expiration DateJune 16, 2028
Laboratory DirectorPaul D. Fortaleza
Laboratory Phone(213) 802-2555
Laboratory LocationPractice Of Medicine2607 Colorado Blvd Ste 200, Eagle Rock, CA 90041
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Practice Of Medicine's NPI number?

The NPI number for Practice Of Medicine is 1629922083. It was assigned to this organization in the NPPES registry on February 23, 2026.

Where is Practice Of Medicine located?

Practice Of Medicine is located at 2607 Colorado Blvd Ste 200, Eagle Rock, CA 90041. The listed phone number is (213) 802-2555.

What is Practice Of Medicine's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Geriatric Medicine, with taxonomy code 207QG0300X.

Does Practice Of Medicine hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2345753) is associated with this NPI, valid through June 16, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Practice Of Medicine was last updated on September 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.