Healthcare Provider Details

I. General information

NPI: 1477969996
Provider Name (Legal Business Name): ANDREW FRERKING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N R ST
LOMPOC CA
93436-5226
US

IV. Provider business mailing address

300 NORTH SAN ANTONIO ROAD, ROOM 107
SANTA BARBARA CA
93110-1332
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-6221
  • Fax:
Mailing address:
  • Phone: 805-681-5461
  • Fax: 805-681-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: