Healthcare Provider Details

I. General information

NPI: 1891053831
Provider Name (Legal Business Name): ANTOINETTE FREGOSO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 MENAUL BLVD NE # 1020
ALBUQUERQUE NM
87110-3379
US

IV. Provider business mailing address

16110 E 14TH ST
ASHLAND CA
94578-3002
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-0276
  • Fax:
Mailing address:
  • Phone: 510-471-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95033328
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11004349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: