Healthcare Provider Details

I. General information

NPI: 1346297165
Provider Name (Legal Business Name): JUAN CARLOS FRISANCHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23600 TELO AVE STE 180
TORRANCE CA
90505-4039
US

IV. Provider business mailing address

23600 TELO AVE STE 180
TORRANCE CA
90505-4039
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-1500
  • Fax: 310-257-1508
Mailing address:
  • Phone: 310-257-1500
  • Fax: 310-257-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA68291
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA68291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: