Healthcare Provider Details

I. General information

NPI: 1326454463
Provider Name (Legal Business Name): EVA FRIED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 18TH ST
ARCATA CA
95521
US

IV. Provider business mailing address

670 9TH ST STE 203
ARCATA CA
95521-6249
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-2481
  • Fax: 707-822-3656
Mailing address:
  • Phone: 707-826-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60813114
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA161821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: