Healthcare Provider Details

I. General information

NPI: 1386798486
Provider Name (Legal Business Name): ALICE FRAUSTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 E CHEVY CHASE DR SUITE 200
GLENDALE CA
91206-4197
US

IV. Provider business mailing address

861 MISTY ISLE DR
GLENDALE CA
91207-1513
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-3445
  • Fax: 818-242-9937
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG41454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: