MEDICARE: FRONTLINE HEALTHCARE-ENDOCRINOLOGY PROFESSIONAL CORPORATION

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1598618787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTLINE HEALTHCARE-ENDOCRINOLOGY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	555 MARIN ST STE 120
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-4102
Country	:	US
Telephone Number	:	805-449-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 MARIN ST STE 120
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-4102
Country	:	US
Telephone Number	:	805-449-1111
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	FUNGWAH CHRIS RUIZ
Credential	:	RN
Telephone Number	:	805-449-1111

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	05/14/2026

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