1215755186 NPI number — CHRISTIAN JOSEPH FRONTERA MSW LSW

Table of content: CHRISTIAN JOSEPH FRONTERA MSW LSW (NPI 1215755186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215755186 NPI number — CHRISTIAN JOSEPH FRONTERA MSW LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRONTERA
Provider First Name:
CHRISTIAN
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW LSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
CHRISTIAN
Provider Other Middle Name:
JOSEPH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215755186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11003 CLIFTON BLVD APT 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44102-1570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-779-9551
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10427 DETROIT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44102-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-521-6511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  S.2411499 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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