MEDICARE: DR. CHRIS ANGELO FRAGISKATOS PH.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	106H00000X	Marriage & Family Therapist	34336	CA

General Provider Information

NPI Number	:	1558409714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS ANGELO FRAGISKATOS PH.D.

Provider Business Mailing Address
First Line	:	3435 CAMINO DEL RIO S
Second Line	:	SUITE 336
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3902
Country	:	US
Telephone Number	:	619-990-4787
Fax Number	:	619-391-8736

Provider Business Practice Location Address
First Line	:	3435 CAMINO DEL RIO S
Second Line	:	SUITE 336
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3902
Country	:	US
Telephone Number	:	619-990-4787
Fax Number	:	619-391-8736

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	03/15/2016

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