Provider Demographics
NPI:1053313684
Name:FRATER, JO ANN MERINO (DC)
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:MERINO
Last Name:FRATER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ANN
Other - Last Name:MERINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3515 SWEETWATER SPRINGS BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1049
Mailing Address - Country:US
Mailing Address - Phone:619-660-6006
Mailing Address - Fax:619-660-0356
Practice Address - Street 1:3515 SWEETWATER SPRINGS BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1049
Practice Address - Country:US
Practice Address - Phone:619-660-6006
Practice Address - Fax:619-660-0356
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T06124Medicare UPIN
DC16382Medicare ID - Type Unspecified