Healthcare Provider Details

I. General information

NPI: 1801359765
Provider Name (Legal Business Name): KRYSTLE DENISE FRAZIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1043 CORONADO AVE APT 6
LONG BEACH CA
90804-3898
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2343
  • Fax: 310-328-0864
Mailing address:
  • Phone: 623-826-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberA180142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: