1851488316 NPI number — DOMINIQUE M. FRADIN-READ M.D.,MPH

Table of content: DOMINIQUE M. FRADIN-READ M.D.,MPH (NPI 1851488316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851488316 NPI number — DOMINIQUE M. FRADIN-READ M.D.,MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRADIN-READ
Provider First Name:
DOMINIQUE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.,MPH
Provider Gender Code:
F

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:
1851488316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5935 PLAYA VISTA DR
Provider Second Line Business Mailing Address:
#415
Provider Business Mailing Address City Name:
PLAYA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90094-2130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-406-1939
Provider Business Mailing Address Fax Number:
310-745-1944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12301 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
#315 VITALIFE-MD
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-325-3368
Provider Business Practice Location Address Fax Number:
424-288-5506
Provider Enumeration Date:
10/06/2006

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: 174400000X , with the licence number:  A92155 , 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)





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