Healthcare Provider Details

I. General information

NPI: 1053283481
Provider Name (Legal Business Name): CHRISTINE MARIE FREY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 W CANYON AVE
SAN DIEGO CA
92123-5429
US

IV. Provider business mailing address

3210 W CANYON AVE
SAN DIEGO CA
92123-5429
US

V. Phone/Fax

Practice location:
  • Phone: 858-309-2177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: