Healthcare Provider Details

I. General information

NPI: 1063985406
Provider Name (Legal Business Name): BRYNN ANNELISE FRAUENHOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 RUFFIN RD STE J
SAN DIEGO CA
92123-1830
US

IV. Provider business mailing address

3959 RUFFIN RD STE J
SAN DIEGO CA
92123-1830
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-5570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304500
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: