Provider Demographics
NPI:1306383385
Name:FRAZER, ANNA MARIE
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:FRAZER
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 1:38414 CHERRY VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92223-4120
Mailing Address - Country:US
Mailing Address - Phone:909-433-1080
Mailing Address - Fax:
Practice Address - Street 1:2220 GIRARD ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5301
Practice Address - Country:US
Practice Address - Phone:951-925-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)