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NPI Code Detail

MEDICARE: MR. MARK RANDALL FRIES

MEDICARE: MR. MARK RANDALL FRIES
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1689836587
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK RANDALL FRIES
Provider Business Mailing Address
First Line : 683 6TH ST
Second Line :
City : HOLLISTER
State : CA
Zip : 95023-3617
Country : US
Telephone Number : 408-607-1879
Fax Number :
Provider Business Practice Location Address
First Line : 16264 CHURCH ST
Second Line :
City : MORGAN HILL
State : CA
Zip : 95037-7130
Country : US
Telephone Number : 408-776-6200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2008
Last Update Date : 06/25/2025

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