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General NPI Number Information
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NPI Number | 1295467447
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Entity Type | Individual
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Provider Name | KEVIN FRYER
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Gender | Male
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 341 MAGNOLIA AVE STE 101
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City | CORONA
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State | CA
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Zip | 92879-3331
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Country | US
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Telephone | 951-735-6060
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Fax | 951-735-4510
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Provider Business Mailing Address
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Address Line | 15101 FAIRFIELD RANCH RD UNIT 14303
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City | CHINO HILLS
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State | CA
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Zip | 91709-8891
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Country | US
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Telephone | 480-628-2692
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 61581
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License Number State | CA
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