MEDICARE: MS. DIANE SUZANNE MASSER-FRYE MS, MSW

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1437148319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE SUZANNE MASSER-FRYE MS, MSW

Provider Business Mailing Address
First Line	:	6131 TAMILYNN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-3426
Country	:	US
Telephone Number	:	858-638-9181
Fax Number	:	858-966-8550

Provider Business Practice Location Address
First Line	:	3020 CHILDRENS WAY
Second Line	:	MC 5031
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-966-5840
Fax Number	:	858-966-8550

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/18/2007

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