Healthcare Provider Details

I. General information

NPI: 1174279525
Provider Name (Legal Business Name): ISRAEL GIDEON FRANK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 CRENSHAW BLVD
LOS ANGELES CA
90043-1810
US

IV. Provider business mailing address

5318 S CRENSHAW BLVD
LOS ANGELES CA
90043
US

V. Phone/Fax

Practice location:
  • Phone: 323-293-6291
  • Fax:
Mailing address:
  • Phone: 415-849-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: