Healthcare Provider Details

I. General information

NPI: 1447738109
Provider Name (Legal Business Name): CUAUHTEMOC FRIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25821 VERMONT AVE
HARBOR CITY CA
90710-3518
US

IV. Provider business mailing address

8414 BEECHWOOD AVE
SOUTH GATE CA
90280-2129
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-2648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number21491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: