Healthcare Provider Details

I. General information

NPI: 1114254182
Provider Name (Legal Business Name): LARI L FRAZEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512 S MCCARRAN BLVD STE D
RENO NV
89509-6141
US

IV. Provider business mailing address

6512 S MCCARRAN BLVD STE D
RENO NV
89509-6141
US

V. Phone/Fax

Practice location:
  • Phone: 775-900-9987
  • Fax: 775-900-9954
Mailing address:
  • Phone: 775-900-9987
  • Fax: 775-900-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A10977
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1746
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: