Provider Demographics
NPI:1538578109
Name:FRECHTMAN, DOUGLAS V (NP)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:V
Last Name:FRECHTMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12635 MAIN ST APT 317
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5274
Mailing Address - Country:US
Mailing Address - Phone:323-507-4388
Mailing Address - Fax:
Practice Address - Street 1:6350 LAUREL CANYON BLVD STE 205
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3278
Practice Address - Country:US
Practice Address - Phone:818-325-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000328363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner