Healthcare Provider Details

I. General information

NPI: 1639448178
Provider Name (Legal Business Name): PASHA SHEREE FRUMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E MAIN ST
BARSTOW CA
92311-3219
US

IV. Provider business mailing address

1301 E MAIN ST
BARSTOW CA
92311-3219
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-3200
  • Fax: 760-255-3210
Mailing address:
  • Phone: 760-255-3200
  • Fax: 760-255-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA22022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: