Healthcare Provider Details

I. General information

NPI: 1851405989
Provider Name (Legal Business Name): HAROLD THOMAS FRANK MS PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST
BRAWLEY CA
92227-2630
US

IV. Provider business mailing address

900 MAIN ST
BRAWLEY CA
92227-2630
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-6471
  • Fax: 760-344-8410
Mailing address:
  • Phone: 760-344-6471
  • Fax: 760-344-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15079
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15079
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA15079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: