Provider Demographics
NPI:1093937823
Name:FRAIM, FANNY JUDITH
Entity Type:Individual
Prefix:MRS
First Name:FANNY
Middle Name:JUDITH
Last Name:FRAIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3043
Mailing Address - Country:US
Mailing Address - Phone:760-489-2146
Mailing Address - Fax:760-489-4129
Practice Address - Street 1:1029 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3043
Practice Address - Country:US
Practice Address - Phone:760-489-4126
Practice Address - Fax:760-489-4129
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator