MEDICARE: ANNALISE FREED

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0800X	Psychiatry Physician	A202850	CA

General Provider Information

NPI Number	:	1851082879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNALISE FREED

Provider Business Mailing Address
First Line	:	11234 ANDERSON STREET, GME OFFICE
Second Line	:	WESTERLY SUITE 'C'
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11234 ANDERSON STREET
Second Line	:	LLUH, PSYCHIATRY RESIDENCY
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	909-558-9532
Fax Number	:

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

Provider Enumeration Date	:	05/19/2023
Last Update Date	:	03/04/2026

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Directions to “ ANNALISE FREED ” Practice Location

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