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General NPI Number Information
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NPI Number | 1205350550
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Entity Type | Individual
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Provider Name | GENNEVE FRERKING RDH
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Gender | Female
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 1625 E 4TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-4201
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Country | US
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Telephone | 213-254-7244
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Fax |
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Provider Business Mailing Address
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Address Line | 7151 TIARA LN
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City | LA PALMA
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State | CA
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Zip | 90623-1157
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Country | US
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Telephone | 928-897-1982
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 26310
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License Number State | CA
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