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General NPI Number Information
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NPI Number | 1548494354
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Entity Type | Individual
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Provider Name | DR. JAMES GORDON FRIESEN
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Gender | Male
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 05/07/2009
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Provider Practice Location Address
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Address Line | 11145 TAMPA AVE SUITE 23A
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City | PORTER RANCH
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State | CA
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Zip | 91326
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Country | US
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Telephone | 818-893-4463
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Fax |
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Provider Business Mailing Address
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Address Line | 9018 BALBOA BL. #538
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City | NORTHRIDGE
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State | CA
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Zip | 91325
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Country | US
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Telephone | 818-893-4463
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY7018
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License Number State | CA
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