Healthcare Provider Details

I. General information

NPI: 1114544558
Provider Name (Legal Business Name): FRIDA KEERU BUNDI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 WASHINGTON BLVD
WHITTIER CA
90602-1006
US

IV. Provider business mailing address

12927 NAVAJO LN
NORWALK CA
90650-3317
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0811
  • Fax: 562-789-5902
Mailing address:
  • Phone: 714-654-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95018571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: