=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659557536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS FRIZETTE DODSON PUA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2008
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16260 VENTURA BLVD
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-998-0387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12741 ROSEBROOK WAY
-----------------------------------------------------
City | STANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90680-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-757-8871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 95028989
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------