Healthcare Provider Details

I. General information

NPI: 1134527740
Provider Name (Legal Business Name): STANLEY FROCHTZWAJG, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 PENINSULA RD #641
OXNARD CA
93035-4059
US

IV. Provider business mailing address

2629 LOMA VISTA RD
VENTURA CA
93003-1548
US

V. Phone/Fax

Practice location:
  • Phone: 901-605-1758
  • Fax:
Mailing address:
  • Phone: 805-641-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23021
License Number StateCA

VIII. Authorized Official

Name: STANLEY FROCHTZWAJG
Title or Position: M.D./OWNER
Credential: M.D.
Phone: 805-641-1780