Healthcare Provider Details

I. General information

NPI: 1215323498
Provider Name (Legal Business Name): JAMAUN FRAZIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9943 CANOGA AVE
CHATSWORTH CA
91311-3002
US

IV. Provider business mailing address

8601 INTERNATIONAL AVE UNIT 222
CANOGA PARK CA
91304-7504
US

V. Phone/Fax

Practice location:
  • Phone: 818-773-0800
  • Fax:
Mailing address:
  • Phone: 818-518-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: