Provider Demographics
NPI:1346297165
Name:FRISANCHO, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:FRISANCHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23600 TELO AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4039
Mailing Address - Country:US
Mailing Address - Phone:310-257-1500
Mailing Address - Fax:310-257-1508
Practice Address - Street 1:23600 TELO AVE STE 180
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4039
Practice Address - Country:US
Practice Address - Phone:310-257-1500
Practice Address - Fax:310-257-1508
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68291207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA68291OtherMEDICAL LICENSE
CAA68291OtherMEDICAL LICENSE