MEDICARE: DR. MARILYN RUTH FRIESEN 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	103T00000X	Psychologist	PSY8986	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699876540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN RUTH FRIESEN PH.D.

Provider Business Mailing Address
First Line	:	4323 N ROGERS RD
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-1222
Country	:	US
Telephone Number	:	619-641-7090
Fax Number	:	619-463-2463

Provider Business Practice Location Address
First Line	:	3111 CAMINO DEL RIO N
Second Line	:	STE 400
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5720
Country	:	US
Telephone Number	:	619-641-7090
Fax Number	:	619-463-2463

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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