Healthcare Provider Details

I. General information

NPI: 1619162831
Provider Name (Legal Business Name): SONDA MARIE FRUDDEN M.A., PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 PEARL ST
MONTEREY CA
93940-3020
US

IV. Provider business mailing address

590 PEARL ST
MONTEREY CA
93940-3020
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-4775
  • Fax: 831-373-3179
Mailing address:
  • Phone: 831-373-4775
  • Fax: 831-373-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: