Healthcare Provider Details

I. General information

NPI: 1225396591
Provider Name (Legal Business Name): MICHAEL FRAZIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14501 MAGNOLIA ST STE 104
WESTMINSTER CA
92683-1307
US

IV. Provider business mailing address

14501 MAGNOLIA ST STE 104
WESTMINSTER CA
92683-1307
US

V. Phone/Fax

Practice location:
  • Phone: 714-908-4524
  • Fax: 657-227-8108
Mailing address:
  • Phone: 714-908-4524
  • Fax: 657-227-8108

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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberA127381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: