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General NPI Number Information
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NPI Number | 1902191125
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Entity Type | Organization
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Legal Business Name | FRONTIER MEDICAL GROUP INC.
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 1016 S ROBERTSON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-1505
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Country | US
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Telephone | 310-652-9283
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Fax | 310-652-9292
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Provider Business Mailing Address
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Address Line | 1016 S ROBERTSON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-1505
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Country | US
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Telephone | 310-652-9283
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Fax | 310-652-9292
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Authorized Official
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Title or Position | GENERAL PRACTICE
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Name | DR. DANIEL DRAKE
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Credential | MD.
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Telephone | 310-652-9283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | A100982
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License Number State | CA
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