Provider Demographics
NPI:1508948001
Name:FRETZ, DAVID BRUCE (IDC 8425)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRUCE
Last Name:FRETZ
Suffix:
Gender:M
Credentials:IDC 8425
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:BRUCE
Other - Last Name:FRETZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IDC 8425
Mailing Address - Street 1:1212 LEYTE RD
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3107
Mailing Address - Country:US
Mailing Address - Phone:619-522-0807
Mailing Address - Fax:
Practice Address - Street 1:USS MOBILE BAY CG 53
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:US
Practice Address - Zip Code:AP
Practice Address - Country:US
Practice Address - Phone:619-556-4576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant