Healthcare Provider Details

I. General information

NPI: 1841528718
Provider Name (Legal Business Name): ANTO THANGARAJ ALDOUS FRITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 E LINCOLN AVE
ANAHEIM CA
92805-4345
US

IV. Provider business mailing address

16702 VALLEY VIEW AVE
LA MIRADA CA
90638-5824
US

V. Phone/Fax

Practice location:
  • Phone: 714-635-2642
  • Fax: 714-635-2547
Mailing address:
  • Phone: 714-367-5391
  • Fax: 714-356-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberBP10058336
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberC159260
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number57548
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: