Provider Demographics
NPI:1811227457
Name:CAROL FREY M.D., INC
Entity Type:Organization
Organization Name:CAROL FREY M.D., INC
Other - Org Name:CAROL FREY M.D., INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-416-9700
Mailing Address - Street 1:1200 ROSECRANS AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2462
Mailing Address - Country:US
Mailing Address - Phone:310-416-9700
Mailing Address - Fax:310-416-1120
Practice Address - Street 1:1200 ROSECRANS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2462
Practice Address - Country:US
Practice Address - Phone:310-416-9700
Practice Address - Fax:310-416-1120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROL FREY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-04
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45808Medicare UPIN
CAG45808Medicare PIN