MEDICARE: MR. FRENZ DAVE MALIC DELFIN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0400X	Rehabilitation Registered Nurse	R108241	AR
2	363LF0000X	Family Nurse Practitioner	95019400	CA

General Provider Information

NPI Number	:	1841952520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRENZ DAVE MALIC DELFIN FNP-C

Provider Business Mailing Address
First Line	:	808 W 58TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-3632
Country	:	US
Telephone Number	:	323-541-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 W 55TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-3620
Country	:	US
Telephone Number	:	323-541-1411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2021
Last Update Date	:	05/18/2022

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