1942468624 NPI number — JOHN G FRAZEE MD A PROFESSIONAL CORPORATION

Table of content: (NPI 1942468624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942468624 NPI number — JOHN G FRAZEE MD A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN G FRAZEE MD A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942468624
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23801 CALABASAS RD
Provider Second Line Business Mailing Address:
SUITE 2035
Provider Business Mailing Address City Name:
CALABASAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91302-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-202-6204
Provider Business Mailing Address Fax Number:
310-202-0831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10833 LECONTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-202-6204
Provider Business Practice Location Address Fax Number:
310-202-0831
Provider Enumeration Date:
05/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FRAZEE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
310-202-6204

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  G33185 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com