Provider Demographics
NPI:1801359765
Name:FRAZIER, KRYSTLE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:DENISE
Last Name:FRAZIER
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 1:1043 CORONADO AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3898
Mailing Address - Country:US
Mailing Address - Phone:623-826-6772
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2343
Practice Address - Fax:310-328-0864
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1801421835P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0200XPharmacy Service ProvidersPharmacistPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program