MEDICARE: ALEX FREITAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	A63146	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326004284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX FREITAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93062-0190
Country	:	US
Telephone Number	:	805-522-5940
Fax Number	:	805-522-6401

Provider Business Practice Location Address
First Line	:	2428 SANTA MONICA BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2045
Country	:	US
Telephone Number	:	310-315-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	12/29/2022

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