Healthcare Provider Details

I. General information

NPI: 1871361543
Provider Name (Legal Business Name): DOUGLAS RYAN FREDONA MSN, FNP-BC, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S MAIN ST
SALINAS CA
93901-2260
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-7777
  • Fax:
Mailing address:
  • Phone: 831-242-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026950
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95026950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: