Healthcare Provider Details

I. General information

NPI: 1285750430
Provider Name (Legal Business Name): SUZANNE FREESEMANN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 N HARBOR BLVD STE 300
FULLERTON CA
92835-2627
US

IV. Provider business mailing address

2720 N HARBOR BLVD STE 300
FULLERTON CA
92835-2627
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-9936
  • Fax:
Mailing address:
  • Phone: 714-879-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: