Healthcare Provider Details

I. General information

NPI: 1851855779
Provider Name (Legal Business Name): ELIZABETH FRIDAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD
PARAMOUNT CA
90723-5433
US

IV. Provider business mailing address

7552 TRABUCO LN
LA PALMA CA
90623-1435
US

V. Phone/Fax

Practice location:
  • Phone: 562-408-0131
  • Fax: 772-252-3337
Mailing address:
  • Phone: 562-257-8635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: