Provider Demographics
NPI:1457864670
Name:FRAUSTO, JESUS M (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:FRAUSTO
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 1:7777 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680
Mailing Address - Country:US
Mailing Address - Phone:714-220-2223
Mailing Address - Fax:714-220-2249
Practice Address - Street 1:7777 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3196
Practice Address - Country:US
Practice Address - Phone:714-220-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79043208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice