Provider Demographics
NPI:1639177892
Name:FRUGONI, CORINNE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:E
Last Name:FRUGONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 23RD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3203
Mailing Address - Country:US
Mailing Address - Phone:707-298-2011
Mailing Address - Fax:707-502-3617
Practice Address - Street 1:2440 23RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3203
Practice Address - Country:US
Practice Address - Phone:707-298-2011
Practice Address - Fax:707-502-3617
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G704781Medicaid
CA00G704781Medicaid
CAF01875Medicare UPIN