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General NPI Number Information
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NPI Number | 1811105117
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Entity Type | Individual
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Provider Name | STEPHEN DAVID FRAUSTO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 5605 W EUGIE AVE STE 111
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City | GLENDALE
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State | AZ
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Zip | 85304-1273
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Country | US
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Telephone | 480-756-6000
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Fax | 855-636-8770
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Provider Business Mailing Address
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Address Line | 5605 W EUGIE AVE STE 111
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City | GLENDALE
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State | AZ
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Zip | 85304-1273
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Country | US
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Telephone | 480-756-0000
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Fax | 855-636-8770
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 36752
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 36752
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License Number State | AZ
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