=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962894923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIC S. FRECHETTE, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2015
-----------------------------------------------------
Last Update Date | 07/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 622 W DUARTE RD STE 304
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91007-9280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-737-6231
-----------------------------------------------------
Fax | 855-515-1574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 622 W DUARTE RD STE 304
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91007-9280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-737-6231
-----------------------------------------------------
Fax | 855-515-1574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIC S FRECHETTE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 626-737-6231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | A117118
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------