Provider Demographics
NPI:1588854426
Name:BRUCE F. FRIEDMAN, M.D., INC.
Entity Type:Organization
Organization Name:BRUCE F. FRIEDMAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-549-9330
Mailing Address - Street 1:11180 WARNER AVE STE 255
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7515
Mailing Address - Country:US
Mailing Address - Phone:714-549-9330
Mailing Address - Fax:714-549-9553
Practice Address - Street 1:11180 WARNER AVE STE 255
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7515
Practice Address - Country:US
Practice Address - Phone:714-549-9330
Practice Address - Fax:714-549-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53565207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52550Medicare UPIN
CAW10203Medicare PIN