Provider Demographics
NPI:1770220428
Name:FRAUTSCHY, KEVIN (LVN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:FRAUTSCHY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 TANGERINE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4567
Mailing Address - Country:US
Mailing Address - Phone:949-648-4090
Mailing Address - Fax:
Practice Address - Street 1:39 TANGERINE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4567
Practice Address - Country:US
Practice Address - Phone:949-648-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250623164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA250623OtherBVNPT (LVN)