Healthcare Provider Details

I. General information

NPI: 1255709838
Provider Name (Legal Business Name): ALEX FRIDMAN MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2015
Last Update Date: 09/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 N FAIRFAX AVE STE 201
WEST HOLLYWOOD CA
90046-7204
US

IV. Provider business mailing address

5334 LINDLEY AVE UNIT 222
ENCINO CA
91316-2905
US

V. Phone/Fax

Practice location:
  • Phone: 323-654-2020
  • Fax: 323-654-2828
Mailing address:
  • Phone: 213-864-4615
  • Fax: 818-357-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA103675
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberA103675
License Number StateCA

VIII. Authorized Official

Name: ALEX FRIDMAN JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 213-864-4615