Provider Demographics
NPI:1407841893
Name:FRAUTSCHI, NANETTE MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:MARIE
Last Name:FRAUTSCHI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:SUITE 291
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1200
Mailing Address - Country:US
Mailing Address - Phone:818-367-2202
Mailing Address - Fax:818-362-1722
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:SUITE 291
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1200
Practice Address - Country:US
Practice Address - Phone:818-367-2202
Practice Address - Fax:818-362-1722
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP9200Medicare ID - Type Unspecified
R61408Medicare UPIN