MEDICARE: JANE LEIGH FREDERICK 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	207VE0102X	Reproductive Endocrinology Physician	G55594	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G55594	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1417927070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE LEIGH FREDERICK M.D.

Provider Business Mailing Address
First Line	:	333 S ARROYO PKWY
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2515
Country	:	US
Telephone Number	:	626-440-9161
Fax Number	:	626-585-1603

Provider Business Practice Location Address
First Line	:	23961 CALLE DE LA MAGDALENA
Second Line	:	SUITE 541
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3616
Country	:	US
Telephone Number	:	909-472-9446
Fax Number	:	949-472-9023

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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