Healthcare Provider Details

I. General information

NPI: 1023625373
Provider Name (Legal Business Name): DINZELL THOMAS ODELL FRAZIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR # 120
OXNARD CA
93036-2612
US

IV. Provider business mailing address

44 GOUGH ST STE 210
SAN FRANCISCO CA
94103-5424
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-9270
  • Fax:
Mailing address:
  • Phone: 716-829-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: