Provider Demographics
NPI:1225398647
Name:FRACE, MARVIN WALDO (DVM-VETERINARIAN)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:WALDO
Last Name:FRACE
Suffix:
Gender:M
Credentials:DVM-VETERINARIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4564 POST ST
Mailing Address - Street 2:STE 100
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-939-1705
Mailing Address - Fax:916-939-1707
Practice Address - Street 1:4564 POST ST
Practice Address - Street 2:STE 100
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762
Practice Address - Country:US
Practice Address - Phone:916-939-1705
Practice Address - Fax:916-939-1707
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4135174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian