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General NPI Number Information
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NPI Number | 1417225244
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Entity Type | Individual
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Provider Name | MR. ISAAC JOSEPH FREDERICK
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Gender | Male
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 310 HARBOR BLVD BLDG E
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City | BELMONT
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State | CA
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Zip | 94002-4018
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Country | US
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Telephone | 650-802-3351
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Fax | 650-591-3043
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Provider Business Mailing Address
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Address Line | 310 HARBOR BLVD BLDG E
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City | BELMONT
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State | CA
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Zip | 94002-4018
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Country | US
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Telephone | 650-802-3351
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Fax | 650-591-3043
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | OH35778
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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