Healthcare Provider Details

I. General information

NPI: 1679054258
Provider Name (Legal Business Name): TOD R FRUEH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 PACIFIC COAST HWY STE N
TORRANCE CA
90505-6657
US

IV. Provider business mailing address

3525 PACIFIC COAST HWY STE N
TORRANCE CA
90505-6657
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-1113
  • Fax: 310-534-3850
Mailing address:
  • Phone: 310-534-1113
  • Fax: 310-534-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA4172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: