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NPI Code Detail

MEDICARE: FRUGE' PSYCHOLOGICAL ASSOCIATES, INC.

MEDICARE: FRUGE' PSYCHOLOGICAL ASSOCIATES, INC.
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 PsychologistPSY18275CA

General Provider Information

NPI Number : 1447679576
Entity Type Code : Organization
Provider Name (Legal Business Name) : FRUGE' PSYCHOLOGICAL ASSOCIATES, INC.
Provider Business Mailing Address
First Line : 1300 CLAY ST STE 600
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1427
Country : US
Telephone Number : 510-759-4405
Fax Number :
Provider Business Practice Location Address
First Line : 1300 CLAY ST STE 600
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1427
Country : US
Telephone Number : 510-759-4405
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : DR. SHAWN LEE FRUGE'
Credential : PSY.D., QME
Telephone Number : 510-759-4405
Provider Enumeration Date : 04/16/2014
Last Update Date : 04/16/2014

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