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NPI Code Detail

MEDICARE: DR. RONALD JAMES FREDERICK JR. PHD

MEDICARE: DR. RONALD JAMES FREDERICK JR. PHD
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
1103TC0700XClinical PsychologistPSY24089CA

General Provider Information

NPI Number : 1417957101
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD JAMES FREDERICK JR. PHD
Provider Business Mailing Address
First Line : 6330 SAN VICENTE BLVD STE 210
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-5441
Country : US
Telephone Number : 612-926-8149
Fax Number :
Provider Business Practice Location Address
First Line : 6330 SAN VICENTE BLVD STE 510
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-5455
Country : US
Telephone Number : 310-275-5075
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 04/22/2026

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