Healthcare Provider Details

I. General information

NPI: 1073726543
Provider Name (Legal Business Name): ALICE FRAUSTO,M,D,,INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG41454
License Number StateCA

VIII. Authorized Official

Name: DR. ALICE FRAUSTO
Title or Position: OWNER
Credential: M,D,
Phone: 818-242-3445