Healthcare Provider Details

I. General information

NPI: 1457345225
Provider Name (Legal Business Name): BRUCE F FRIEDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 WARNER AVE SUITE 255
FOUNTAIN VALLEY CA
92708-7501
US

IV. Provider business mailing address

11180 WARNER AVE SUITE 255
FOUNTAIN VALLEY CA
92708-7501
US

V. Phone/Fax

Practice location:
  • Phone: 714-549-9330
  • Fax: 714-549-9553
Mailing address:
  • Phone: 714-549-9330
  • Fax: 714-549-9553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberG53565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: