Healthcare Provider Details

I. General information

NPI: 1134598014
Provider Name (Legal Business Name): CYNTHIA LOUISE FREDERICKSON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA LOUISE FREY AUD

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 GATEWAY OAKS DR STE 100
SACRAMENTO CA
95833-4346
US

IV. Provider business mailing address

LOMA LINDA UNIVERSITY HEALTHCARE 11234 ANDERSON STREET, ROOM: 2586A
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 951-324-4929
  • Fax:
Mailing address:
  • Phone: 909-558-7884
  • Fax: 909-558-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number144107
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3136
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5864
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: