Provider Demographics
NPI:1710094024
Name:FREYALDENHOVEN, STEPHEN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:FREYALDENHOVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:310 JAMES WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2876
Mailing Address - Country:US
Mailing Address - Phone:805-556-6001
Mailing Address - Fax:805-773-4232
Practice Address - Street 1:310 JAMES WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2876
Practice Address - Country:US
Practice Address - Phone:805-556-6001
Practice Address - Fax:805-773-4232
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA629296208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH02411Medicare UPIN
CAW13876Medicare ID - Type Unspecified