Provider Demographics
NPI:1477087005
Name:FRIPP, NATHANIEL
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:FRIPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 LAKE PARK AVE
Mailing Address - Street 2:SUITE 329
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2730
Mailing Address - Country:US
Mailing Address - Phone:510-789-5565
Mailing Address - Fax:
Practice Address - Street 1:484 LAKE PARK AVE
Practice Address - Street 2:SUITE 329
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2730
Practice Address - Country:US
Practice Address - Phone:510-789-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0G02106251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management