Healthcare Provider Details

I. General information

NPI: 1275538241
Provider Name (Legal Business Name): DANIEL JOSEPH FRASCHETTI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57445 TWENTY-NINE PALMS HIGHWAY SUITE 302
YUCCA VALLEY CA
92284
US

IV. Provider business mailing address

57445 TWENTY-NINE PALMS HWY SUITE 302
YUCCA VALLEY CA
92284
US

V. Phone/Fax

Practice location:
  • Phone: 760-369-9220
  • Fax: 760-369-9232
Mailing address:
  • Phone: 760-369-9220
  • Fax: 760-369-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A8445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: